APRV Workshop by Dr. Nader M. Habashi, MD, FACP, FCCP

Introduction

This tutorial provides a comprehensive overview of Airway Pressure Release Ventilation (APRV) as discussed in the workshop led by Dr. Nader M. Habashi. APRV is a mode of mechanical ventilation designed to improve oxygenation and ventilation in patients with respiratory distress. Understanding this technique is essential for healthcare professionals involved in critical care and respiratory therapy.

Step 1: Understand the Basics of APRV

• Definition: APRV is a mode of mechanical ventilation that allows spontaneous breathing throughout the respiratory cycle.
• Key Features:
  • Two distinct pressure levels: High pressure (Phigh) and Low pressure (Plow).
  • Time-controlled release of pressure to facilitate exhalation.
  • Encourages lung recruitment and improves oxygenation by maintaining higher mean airway pressures.

Practical Advice

• Familiarize yourself with the settings of APRV, including Phigh and Plow, as well as the duration of time at each pressure level.

Step 2: Setting Up APRV on the Ventilator

• Initial Settings:
  • Set Phigh to achieve desired tidal volume and oxygenation (typically 20-30 cmH2O).
  • Set Plow to a level that prevents airway collapse (often 0-5 cmH2O).
  • Determine the release time (Trelease) to allow for effective CO2 elimination (generally 0.5-1.5 seconds).

Practical Advice

• Monitor patient response closely and adjust settings based on arterial blood gas results and clinical indicators.

Step 3: Monitoring and Adjusting APRV

• Patient Monitoring:

  • Regularly check vital signs, blood gas levels, and ventilator parameters.
  • Assess for signs of respiratory distress or discomfort.

• Adjustments:

  • If oxygenation is inadequate, consider increasing Phigh or adjusting the release time.
  • If patient comfort is compromised, evaluate the need for sedation or analgesia.

Common Pitfalls to Avoid

• Avoid overly aggressive settings that may lead to barotrauma or volutrauma.
• Ensure that the patient is not overly sedated, which can inhibit spontaneous breathing efforts.

Step 4: Weaning Off APRV

• Criteria for Weaning:
  • Evaluate the patient’s ability to maintain adequate oxygenation and ventilation.
  • Consider the presence of stable hemodynamics and improved lung function.

Weaning Process

• Gradually decrease Phigh and increase Plow while monitoring the patient’s response.
• Transition to a traditional ventilation mode when appropriate.

Conclusion

Understanding and effectively implementing APRV can significantly enhance patient outcomes in critical care settings. Key takeaways include mastering the initial setup, continuous patient monitoring, and being prepared to make necessary adjustments. As you become more familiar with APRV, it is crucial to stay updated with best practices and emerging research in ventilatory support. Consider further education through workshops or online courses to deepen your knowledge and skills in advanced ventilation techniques.