Airway pressure release ventilation
- Also known as BiVent, depending on the ventilator manufacturer
- Uses high constant pressure (Phigh) to recruit alveoli ("open lung" ventilation) with intermittent mandatory releases, if minimal to no respiratory acidosis
- Inverse ratio
- Pressure controlled
- Intermittent mandatory ventilation
- With unrestricted spontaneous breathing
- Severe ARDS, rescue therapy
- Full benefit of APRV is in patients that are not paralyzed that can provide spontaneous breaths
- Main limitation is respiratory acidosis given minimal ventilation
- Start PHigh at PPlat if on volume control or peak pressure if on pressure control, try not to go beyond 35 cmH2O
- PPlateau = desired Pmean + 3 cmH2O
- PLow at 0 cmH2O for maximal expiration
- THigh at 4.5-6 seconds (inspiratory time)
- Tlow at 0.5-0.8 seconds (expiratory time), with TV 4-6 cc/kg
- Automatic tube compensation ON if patient spontaneously breathing
- Wean by "dropping and stretching"
- Every two hours or as tolerated, decrease PHigh by 1-2 cmH2O and increasing THigh by 0.5 seconds per 1 cmH2O drop in PHigh
- Monitor for drop in SpO2, increased work of breathing, tachypnea
- Once PHigh reaches 10 cmH2O and THigh reaches 12-15 seconds with spontaneous respirations, change mode to CPAP with PEEP 10 cmH2O and PS 5-10 cmH2O, turn ATC off
- Noninvasive ventilation
- Mechanical ventilation (main)
- Ventilation modes
- Initial mechanical ventilation settings
- Adjusting mechanical ventilation settings
- Weaning mechanical ventilation
- CriticalCareNow: APRV PEEP to the Max
- Life in the Fast Lane: Airway Pressure Release Ventilation
- PulmCrit: APRV
- CritCareMed. 2005;33:S228 Other Approaches to Open-Lung Ventilation–Airway Pressure Release Ventilation.
- CleveClinJMed 2011;78:101 Airway Pressure Release Ventilation–Alternative Mode of Mechanical Ventilation in Acute Respiratory Distress Syndrome.
- Guttmann J et al. Automatic tube compensation (ATC). Minerva Anestesiol. 2002 May;68(5):369-77.