I have more reading to do as I am a bit on a budget for time today. I have sort of bold typed your message. Thanks as usual for a the exhaustive concordance on the mode. I have read the Habashi papers and they have greatly aided me in determining starting, and weaning points from the mode.
I am still interested to learn more about VDR. Interesting concept though now we have Type B 3100s we are likely to jump straight to a classic oscillator in these advanced scenarios. Though the jury is still out on this adjunct as well.
My appreciation for APRV is in as much as that it does a good job of increasing MAP. As in classical HF I would still hold that Amp(Power) does relate to MAP however MAP/PEEP is still the higher power in oxygenation. Having said that a lower frequency does generate a larger area of ventilation I still wonder does it affect oxygenation as much?
I appreciate your annecdotes regarding speed of light and the limitations to PS with APRV. I have read the 840 manual in otherwords. I do find this interesting.
I think that I would have never actually considered using APRV at such enormous rates for numerous safety reasons not to mention the desirable state of the patient is to be intact with a drive to breath or so I thought. Your experience seems to be otherwise. More reading required on my part Im afraid.
Don't really have anything intelligent to add just wanted to say Hi and Thanks Light and Jeff for the comments.
I understand that the capabilities of the APRV mode are greater than that of PCV+assist. However, APRV is just now begining to reach a level of communication on a national level. Every recent national convention (to my knowledge) will have one lecture, maybe, on APRV but 10-15 on conventional ventilation. When people hear you speak of APRV with rates of 200, they might think that is how APRV is to be used. Now I am not saying that you can't tweak the mode to do what you need, but for simplicity APRV needs to mean one thing. Even when they started using PC-IRV that added the qualifier of IRV. APRV should stay APRV.
Jeff what would you do if you had an asthmatic in a status situation right after a severe accident with rib fractures, lung contusions, hemothorax, PAH, and all you had was a Mark 10. Could you do it?
This is when creativity and knowledge comes into play. Not the general discussion of a mode. Although I liked the example. My students when given a situation will state that want to do ______ to assist the patient. I respond with "your hospital doesn't have that, what now", then they give another reply and so on and so on. I use this to test their knowldege of the possibilities. I get it.
We have used APRV on a COPD patient when we were told we couldn't. http://www.rcjournal.com/abstr...id=OF-05-199%20Haire
For those that have used APRV and IPV together. How high has your Phigh been with using IPV? Have you tried IPV with a patient that was also being proned?
Our last H1N1 pt was on 32/0 in the rotoprone bed and getting Q4 IPV tx. The one concern was the extra weight of the cone and phasitron during the tx placing extra pressure on the ET tube. Be sure to have a cuff leak during tx. because all the secretions are already leaking downward.
Thanks Wade for sharing your experience. Did IPV make a difference with the H1N1 patient?
Does anyone know if you can induce a cuffleak on aprv for CO2 elimination.