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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?

20
Q

Why is autoPEEP built into APRV?

A

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

21
A patient with compliance issues should have their expiration end when?
75% of PEFR
21
When should expiratory flow end when a patient is on APRV?
Should end 50-75% of PEFR
22
What determines tidal volume in APRV?
Pressure gradient between Phigh and Plow Duration of T high Patients pulmonary mechanics
23
How should the expiration change as the patient improves?
Can end closer to 25% of PEFR
24
What determines a patients alveolar ventilation and PaCO2 on APRV?
Tidal volume Frequency of airway pressure release maneuver Level of patients spontaneous breathing
25
What should you assess after initiating APRV?
SpO2 HR Blood pressure Minute ventilation Expiratory flow curve ABG
26
If APRV is successfully implemented, what should the WOB look like and what muscle group will be doing most of the WOB?
Decrease work of breathing Focuses WOB on diaphragm and allows accessory muscles to rest
26
If you need to increase a patients SpO2, what are your options on APRV?
Increase FiO2 Increase Phigh in 2 cmH2O increments Decrease Tlow to be closer to 75% of PEFR
27
What should be done intially if a patient on APRV begins to develop a respiratory acidosis?
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
What should be done if a patient on APRV has a persistent respiratory acidosis and initial interventions do not help?
Decrease Thigh Increase Phigh to maintain MAP and maintain alveolar recruitment
29
If a patient on APRV develops a respiratory alkalosis, what adjustments should be made?
Decrease Phigh to lower delta P in 2 cm H2O increments Increase Thigh to decrease cycles per minute
30
How should a patient on APRV be weaned?
FiO2 should be weaned first
31
What FiO2 should be targeted when weaning a patient on APRV?
Target 50% with SpO2 of 88%
32
How should Thigh be treated when weaning APRV?
Stretch Thigh by 0.5 seconds until Thigh is 12-15 seconds
33
How should Phigh be weaned for a patient on APRV?
Drop Phigh in 2 cmH2O increments until Phigh is below 10 cm H2O
34
What are the advantages of APRV?
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
What mode should you transfer a patient who is improving on APRV to?
When appropriate, you can shift a patient onto PSV 10/5
35
What are the disadvantages of APRV
Variable tidal volumes Minimum minute ventilation not guaranteed autoPEEP High MAPs may reduce venous return in hemodynamic unstable patients
36
What patients have contraindications for the use of APRV?
Severe obstructive lung disease
37
What does Phigh to Plow allow?
allows lungs to deflate
37
Why should patients with severe obstructive lung disease not be put on APRV?
Significant chance of severe air trapping and barotrauma
38
How is tidal volume determined on APRV
patients pulmonary mechanics duration of Thigh pressure gradient between Phigh and Plow
39
What should Tlow be set to?
set to end expiratory flow at about 50-75% of PEF
39
When using the last conventional mode of ventilation as a reference, Phigh should be set to
At PIP At the Pplat At 3 cmH2O above the MAP
40
What does Plow to Phigh do?
inflates the lungs
41
The patients alveolar ventilation and PaCO2 are determined by __________ in APRV
frequency of airway release maneuver Plow the level of the patients spontaneous breathing the tidal volume
42
What is a contraindication for APRV
congestive heart failure
43
what are indications for the use of APRV
acute lung injury atelectasis requiring >50% FiO2 diffuse pneumonia
44
What are the goals of APRV
decreasing PIPs improving oxygenation reducing dead space
45
APRV could be best described as a:
mode of ventilatory support designed to provide two levels of CPAP

Clinical Instruction (Kass) (13 decks)

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