APRV in Severe ARDS | How to Set It, Adjust It & Wean It.
ICU Fellow
119 views
In this video, we discuss *Airway Pressure Release Ventilation (APRV)* and its practical use as a salvage ventilation strategy in patients with **severe ARDS and refractory hypoxaemia**.
The lecture focuses on understanding the physiology behind APRV and, more importantly, how to actually set it up and adjust it at the bedside.
Topics covered include:
• What APRV is and how it works
• Why APRV increases mean airway pressure
• Recruitment of collapsed alveoli
• The importance of pressure and time in lung recruitment
• APRV vs conventional pressure-controlled ventilation
• Oxygenation vs ventilation in APRV
• Ideal patient selection
• P-high, P-low, T-high and T-low
• Suggested initial APRV settings
• Why P-low is often set at zero
• Release volume and CO₂ clearance
• Adjusting T-low using the expiratory flow curve
• Terminating expiration at approximately 50–75% of peak expiratory flow
• Creating intrinsic PEEP to prevent derecruitment
• Pressure-time and flow-time waveform interpretation
• Adjusting APRV for hypoxaemia
• Adjusting APRV for hypercapnia
• Permissive hypercapnia
• Spontaneous breathing during APRV
• Sedation and paralysis
• Barotrauma, RV dysfunction and haemodynamic complications
• Why APRV should be used cautiously in obstructive lung disease
• Weaning APRV using the “drop and stretch” technique
• Transitioning from APRV toward CPAP and spontaneous breathing
The central concept of APRV is:
*Keep the alveoli recruited for most of the respiratory cycle → briefly release pressure for ventilation → terminate expiration before complete derecruitment occurs.*
APRV can be particularly useful in selected patients with **severe, recruitable ARDS and refractory hypoxaemia**, but it requires close bedside attention to ventilator waveforms, lung mechanics and haemodynamics.
Let me know what future topics need to be covered.
#APRV #ARDS #MechanicalVentilation #ICU #CriticalCare #Ventilation #Hypoxemia #RespiratoryFailure #FOAMcc #IntensiveCare
00:00 Introduction.
01:24 What is APRV?
02:02 Why to increase the mean AW pressure.
04:25 Berlin definition ARDS
05:00 Rethink ARDS.
06:04 Why not just increase PEEP?
07:14 PCV.
08:25 why APRV in hypoxia ?
09:52 Evidence, bilevel-APRV.
11:11 an analogy!
12:24 Mental image of APRV
12:59 Fundamental APRV settings.
13:28 General guidelines for initial settings.
15:02 P- High
16:07 P- Low
17:28 Delta pressure.
18:00 Release volume
18:21 PCV vs APRV
18:42 T- High
19:19 How to set mandatory RR
20:08 T- Low
22:14 Which ventilator Waveforms to watch
24:06 APRV needs close bedside attention.
25:13 Troubleshooting hypercapnia.
26:17 Troubleshooting APRV for hypoxemia
27:05 Oxygenation ventilation battle
27:49 Paralysis in APRV
28:46 Permissive Hypercapnea
29:04 APRV and obstructive lung disease
29:40 Weaning APRV
APRV in Severe ARDS | How to Set It, Adjust It & Wean It.
ICU Fellow
119 views
In this video, we discuss *Airway Pressure Release Ventilation (APRV)* and its practical use as a salvage ventilation strategy in patients with **severe ARDS and refractory hypoxaemia**.
The lecture focuses on understanding the physiology behind APRV and, more importantly, how to actually set it up and adjust it at the bedside.
Topics covered include:
• What APRV is and how it works
• Why APRV increases mean airway pressure
• Recruitment of collapsed alveoli
• The importance of pressure and time in lung recruitment
• APRV vs conventional pressure-controlled ventilation
• Oxygenation vs ventilation in APRV
• Ideal patient selection
• P-high, P-low, T-high and T-low
• Suggested initial APRV settings
• Why P-low is often set at zero
• Release volume and CO₂ clearance
• Adjusting T-low using the expiratory flow curve
• Terminating expiration at approximately 50–75% of peak expiratory flow
• Creating intrinsic PEEP to prevent derecruitment
• Pressure-time and flow-time waveform interpretation
• Adjusting APRV for hypoxaemia
• Adjusting APRV for hypercapnia
• Permissive hypercapnia
• Spontaneous breathing during APRV
• Sedation and paralysis
• Barotrauma, RV dysfunction and haemodynamic complications
• Why APRV should be used cautiously in obstructive lung disease
• Weaning APRV using the “drop and stretch” technique
• Transitioning from APRV toward CPAP and spontaneous breathing
The central concept of APRV is:
*Keep the alveoli recruited for most of the respiratory cycle → briefly release pressure for ventilation → terminate expiration before complete derecruitment occurs.*
APRV can be particularly useful in selected patients with **severe, recruitable ARDS and refractory hypoxaemia**, but it requires close bedside attention to ventilator waveforms, lung mechanics and haemodynamics.
Let me know what future topics need to be covered.
#APRV #ARDS #MechanicalVentilation #ICU #CriticalCare #Ventilation #Hypoxemia #RespiratoryFailure #FOAMcc #IntensiveCare
00:00 Introduction.
01:24 What is APRV?
02:02 Why to increase the mean AW pressure.
04:25 Berlin definition ARDS
05:00 Rethink ARDS.
06:04 Why not just increase PEEP?
07:14 PCV.
08:25 why APRV in hypoxia ?
09:52 Evidence, bilevel-APRV.
11:11 an analogy!
12:24 Mental image of APRV
12:59 Fundamental APRV settings.
13:28 General guidelines for initial settings.
15:02 P- High
16:07 P- Low
17:28 Delta pressure.
18:00 Release volume
18:21 PCV vs APRV
18:42 T- High
19:19 How to set mandatory RR
20:08 T- Low
22:14 Which ventilator Waveforms to watch
24:06 APRV needs close bedside attention.
25:13 Troubleshooting hypercapnia.
26:17 Troubleshooting APRV for hypoxemia
27:05 Oxygenation ventilation battle
27:49 Paralysis in APRV
28:46 Permissive Hypercapnea
29:04 APRV and obstructive lung disease
29:40 Weaning APRV