I have neen trying over and over since i graduated to learn abt APRV and how to apply it on patients, allow me to say bravo bravo, that's why RTs are the best when it comes to explaining mechanical ventilation, i have never heard or had APRV explained to me this well and in full detail like your video. Jason my man you have made my APRV-section n my carrier a lot easier

@pulmovista500guidedaprv2

3 жыл бұрын

Wow. Thank you so much for the kind words. More APRV case studies to come. Most of my other videos are APRV case studies and combining the mode with Electrical Impedance Tomography (PulmoVista 500) from Drager company. kzread.info/dash/bejne/e6eGwbBwqLvfgbg.html ☝️☝️☝️☝️ Another good APRV video. Make sure to add a slope if setting is available which will increase tidal volume. The video shows the changes in VT just by manipulating the slope. Look up TCAV with Dr. Nader Habashi. TCAV stands for (Time Controlled Adaptive Ventilation ) and is how we should use APRV. Thanks again for the encouragement. What medical profession are you?;

@NZN5555

3 жыл бұрын

@@pulmovista500guidedaprv2 thats very interesting! I’ll read more abt it before i watchh ur video so i can have an idea 👍🏼

@pulmovista500guidedaprv2

2 жыл бұрын

The video can be viewed first. It explains from A to Z. Let me know what you think and please ask me any additional questions. I'd be glad to respond

👍🏻

Thank you for the great content!! 1.)How might you go from weaning APRV to conventional settings amongst patients who are not spontaneously breathing? 2.) How might you approach initial settings in patients who are not spontaneously breathing?

@pulmovista500guidedaprv2

7 ай бұрын

You set the T-High lower, creating more releases that will be equivalent to setting an RR. So, set the desired minute ventilation and adjust when you get your blood gas.

Well explained, just a question why we try to find ideal PEEP on VCAC then we take a Pplat why we don’t take a Pplat directly in order to set P high?

@pulmovista500guidedaprv2

Жыл бұрын

You set it on conventional with the protective lung strategy. The optimal PEEP in ACVC will give you the best Pdrive (delta P), and from that, you use the Pplat as a good "starting" point for Phigh setting. It's just gives you a good starting point.

@pulmovista500guidedaprv2

Жыл бұрын

It's because APRV can feel foreign to new users. So, helping to decide a good starting point, Pplat from ACVC with optimal PEEP, lowest Pdrive & 6 to 8 ml/kg VT........whatever the Pplat is try starting there. From that initial setting, you adjust. I could start doing a livestream where we can all discuss these topics and other topics on mechanical ventilation.

Hello..Can you use APRV MODE on Covid ARDS pts that are Vec drip? pts that are completely sedated and paralyze

@pulmovista500guidedaprv2

3 жыл бұрын

Yes you can use APRV as a control mode by setting the T-High setting low. This creates more releases down to the P-Low setting which is how you create mandatory breaths with APRV. A T-High of 1.5 sec usually creates around 30 to 35 breaths per minute. Patient can be completely paralyzed.👍 With Drager PC-APRV mode you get the benefits of a control mode with no trigger which aids in synchrony. With a low T-high setting of 1.5 secs you get about 30 to 35 breaths/min with a I:E ratio 3.5:1 which you can't get with any other mode. We use PC-APRV on Drager vent for our COVID patients specifically because of the AUTO-RELEASE option that allows you to set and EXP. TERM %. When set at 75% the P-Low actually arrives at the optimal peep (+/- 1cmH20 ) on the majority of patients. So with PC-APRV I'm confident that peep is optimally set with auto-release option. I've seen this option only with Drager. Very well configured mode. ehced.org/aprv-tcav/ Hopefully this helps ☝️☝️☝️

When do you decide to shift the ards patient to APRV mode? Or do you usually try first the low Vt of 4-6ml/kg high rr strategy before shifting the patient to APRV?

@pulmovista500guidedaprv2

2 жыл бұрын

We use early APRV instead of rescue when nothing else works. We set everything with PulmoVista 500 electrical Impedance Tomography. If traditional modes with PulmoVista show better results we use traditional modes. If APRV shows better results we use it. We use the TCAV method outlined by Dr. Nader Habashi. TCAV is time controlled adaptive ventilation. We limit the expiratory phase from Phigh to Plow by stopping the release phase when the expiratory flow descends to 75% of the peak expiratory flow. This would be equivalent to APRV optimal peep. The Drager vent uses auto release which does the 75% for us automatically. Phigh is usually set where Pplat is. This is a good starting point. The Plow and Tlow are created with the 75% auto release (exp. Termination). If the patient need alot of support we use a short Thigh and the breathing profile is similar to ACPC however you don't have a trigger which really helps with synchrony. When Vt get to high we wean the Phigh to respect the 6 ml/kg to 8ml/kg. For sure we will use the lower TV of 5 ml/kg or even 4 ml/kg if needed.👍 We still respect the drive pressure targets below 15 cmh20. With APRV you start with a short Thigh and as the blood gas C02 clearance is adequate we slowly stretch the Thigh to optimize diffusion. So you start with a ACPC profile and as you stretch the Thigh you encourage more spontaneous breathing on the Phigh (which is a CPAP level). That's why Drager vent mode is called PC-APRV. Small Thigh =ACPC with no trigger. Longer Thigh begins to look like traditional APRV taking advantage of lung diffusion. We use PulmoVista 500 electrical inpedance Tomography to set traditional modes and well as APRV so we have regional compliance data as well as end expiratory volume trends and end Insp. Volune trends. If the patient is recruitable or higher peeps are optimal APRV works very well cause recruitment is pressure over time. If you can stretch the Thigh you increase time and often need less pressure for recruitment. Hard to explain with a text. Please search APRV, TCAV, DR. NADER HABASHI, Drager

At 1755 Why would you say that vents that don't have auto release might need to have PEEP/Plow set above 0? Don't think so. But overall good and something I'd pass on for others to watch

@pulmovista500guidedaprv2

2 жыл бұрын

You are 100% correct and I agree with you. Thank you for brining this to my attention. I have edited this part of the video out. When this video was made I only used APRV with V500 and always used the auto release which gives us the option to use (expiratory term %) and set it at 75%. Machine does the calculation and adjustments automatically. I have used it for an additional 2 years and with various vents like PB 980 and set the P-low at zero. Thanks for watching the video, visiting my channel and giving important feedback. Greatly appreciated

You said add Thigh and Tlow and dividethem by 60 would give you breaths per minute. And then in the example again you said divide by 60. But 6 divided by 60 is 0.1. You have to do the opposite, as you illustrated in the example, 60 divided by 6. It isn’t the same. Just throwing it out there in case there any newbs who might be confused, like I was a little before the illustrated example, and was like, “ohhhh! Of course! Duh!” Lolol

@pulmovista500guidedaprv2

2 жыл бұрын

Crap. Ya that was a mistake. Said it backwards. Hopefully people got what I was trying to say. Thanks for letting me know

@deendrew36

2 жыл бұрын

@@pulmovista500guidedaprv2 lol! I am sure others were quicker on the uptake than I was! I am a NICU RT and we don’t use this mode. I know they use it in our adult ICU, so I thought I would check it out. Great in service, overall.

@pulmovista500guidedaprv2

2 жыл бұрын

@@deendrew36 To bad I can't edit it and fix the mistake. I'm in Canada, Quebec. Where are you at ?

@deendrew36

2 жыл бұрын

@@pulmovista500guidedaprv2 I am in Ottawa! We are neighbours!

@pulmovista500guidedaprv2

2 жыл бұрын

@@deendrew36 Ha ha. Cool 👍😎 Small world.

Thank you, if you are still here I want to text you on private

@pulmovista500guidedaprv2

Жыл бұрын

jjswartz79@gmail.com