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Clinical Instruction (Kass) > APRV > Flashcards

APRV Flashcards

1
Q

At it simplest, what is APRV?

A

A mode of ventilatory support designed to provide 2 levels of CPAP

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2
Q

T/F: APRV does not allow for spontaneous breathing

A

False. APRV allows for spontaneous breathing at both levels

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3
Q

What are the general indications for APRV?

A

Acute lung injury
Diffuse pneumonia
Atelectasis requiring >50% FiO2
Tracheoesophageal fistula

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4
Q

What are the goals of APRV

A

Improve oxygenation
Reduce physiological dead space
Decrease PIP

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5
Q

What are the most common patients receiving APRV?

A

ARDS patients

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6
Q

What is APRV called on the Drager and Evita?

A

APRV

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7
Q

What is APRV called on the Hamilton?

A

APRV
DuoPAP

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8
Q

What is APRV called on the servo?

A

BiVent

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8
Q

What is APRV called on Covidien?

A

Bi-level

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9
Q

What are the initial settings for FiO2 on APRV?

A

FiO2 starts at 90%

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10
Q

What is the goal for SpO2 when using APRV?

A

Titrate O2 for an SpO2 of >88%

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11
Q

What does Phigh represent?

A

Inspiratory pressure

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12
Q

What does Plow represent?

A

PEEP

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13
Q

What does T high represent?

A

Inspiratory time

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14
Q

What is the function of Phihg?

A

Promotes alveolar stabilization and alveolar recruitment

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14
Q

What does Tlow represent?

A

Expiratory time

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15
Q

What is Phigh usually set to?

A

20-30 cmH2O at initiation

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16
Q

What is Thigh initially set to?

A

4.5-6 seconds

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16
Q

What is Plow set to?

A

0 cmH2O

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16
Q

What is Tlow initially set to?

A

0.5-0.8 seconds

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17
Q

What is the purpose of Plow?

A

Promotes CO2 removal
Lowers mean airway pressure
Reduces risk of cardiac compromise

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18
Q

How is Phigh set?

A

Set at Plateau pressure (volume control)
Set at 3 cmH2O above MAP
PIP (pressure control)

19
Q

What should Phigh be kept below?

A

40 cm H2O

20
Q

Why is autoPEEP built into APRV?

A

It maintains alveolar recruitment and prevents the collapse and re-expansion of the alveoli

21
Q

A patient with compliance issues should have their expiration end when?

A

75% of PEFR

21
Q

When should expiratory flow end when a patient is on APRV?

A

Should end 50-75% of PEFR

22
Q

What determines tidal volume in APRV?

A

Pressure gradient between Phigh and Plow
Duration of T high
Patients pulmonary mechanics

23
Q

How should the expiration change as the patient improves?

A

Can end closer to 25% of PEFR

24
Q

What determines a patients alveolar ventilation and PaCO2 on APRV?

A

Tidal volume
Frequency of airway pressure release maneuver
Level of patients spontaneous breathing

25
Q

What should you assess after initiating APRV?

A

SpO2
HR
Blood pressure
Minute ventilation
Expiratory flow curve
ABG

26
Q

If APRV is successfully implemented, what should the WOB look like and what muscle group will be doing most of the WOB?

A

Decrease work of breathing
Focuses WOB on diaphragm and allows accessory muscles to rest

26
Q

If you need to increase a patients SpO2, what are your options on APRV?

A

Increase FiO2
Increase Phigh in 2 cmH2O increments
Decrease Tlow to be closer to 75% of PEFR

27
Q

What should be done intially if a patient on APRV begins to develop a respiratory acidosis?

A

Increase Phigh in 2 cmH2O increments
Increase Thigh in increments of 0.5 second increments
Increase T low to allow for more time for exhalation

28
Q

What should be done if a patient on APRV has a persistent respiratory acidosis and initial interventions do not help?

A

Decrease Thigh
Increase Phigh to maintain MAP and maintain alveolar recruitment

29
Q

If a patient on APRV develops a respiratory alkalosis, what adjustments should be made?

A

Decrease Phigh to lower delta P in 2 cm H2O increments
Increase Thigh to decrease cycles per minute

30
Q

How should a patient on APRV be weaned?

A

FiO2 should be weaned first

31
Q

What FiO2 should be targeted when weaning a patient on APRV?

A

Target 50% with SpO2 of 88%

32
Q

How should Thigh be treated when weaning APRV?

A

Stretch Thigh by 0.5 seconds until Thigh is 12-15 seconds

33
Q

How should Phigh be weaned for a patient on APRV?

A

Drop Phigh in 2 cmH2O increments until Phigh is below 10 cm H2O

34
Q

What are the advantages of APRV?

A

Decrease PIP
Improve alveolar recruitment
Improve oxygenation
Improve gas exchange
Allows for spontaneous breathing = improvements in recruitment and gas exchange
Potential decrease in need for sedation and paralytics, time on vent, and length of ICU stay

34
Q

What mode should you transfer a patient who is improving on APRV to?

A

When appropriate, you can shift a patient onto PSV 10/5

35
Q

What are the disadvantages of APRV

A

Variable tidal volumes
Minimum minute ventilation not guaranteed
autoPEEP
High MAPs may reduce venous return in hemodynamic unstable patients

36
Q

What patients have contraindications for the use of APRV?

A

Severe obstructive lung disease

37
Q

What does Phigh to Plow allow?

A

allows lungs to deflate

37
Q

Why should patients with severe obstructive lung disease not be put on APRV?

A

Significant chance of severe air trapping and barotrauma

38
Q

How is tidal volume determined on APRV

A

patients pulmonary mechanics
duration of Thigh
pressure gradient between Phigh and Plow

39
Q

What should Tlow be set to?

A

set to end expiratory flow at about 50-75% of PEF

39
Q

When using the last conventional mode of ventilation as a reference, Phigh should be set to

A

At PIP
At the Pplat
At 3 cmH2O above the MAP

40
Q

What does Plow to Phigh do?

A

inflates the lungs

41
Q

The patients alveolar ventilation and PaCO2 are determined by __________ in APRV

A

frequency of airway release maneuver
Plow
the level of the patients spontaneous breathing
the tidal volume

42
Q

What is a contraindication for APRV

A

congestive heart failure

43
Q

what are indications for the use of APRV

A

acute lung injury
atelectasis requiring >50% FiO2
diffuse pneumonia

44
Q

What are the goals of APRV

A

decreasing PIPs
improving oxygenation
reducing dead space

45
Q

APRV could be best described as a:

A

mode of ventilatory support designed to provide two levels of CPAP

Clinical Instruction (Kass) (13 decks)

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