Hello Everyone,

First post, long time reader.
How many of you are using Bivent/APRV modes in your PICU/Trauma Centers.
Our facility will be currently accepting all pediatric trauma cases and we are very successful using Bivent with our adult trauma...so I was thinking, could we continue our success with peds.

Your input or opinions (pros & cons) would greatly be appreciated.

Wade

We have used APRV in our pediatric ICU with good results. However the one thing we found is that we would like fine controls over the Tlow. sometimes 0.1 seconds was to large of movemments, Drager now with the upgraded software alllows for 0.05 second changes(we do not have this upgrade)

Hello Light,

Thanks for your response.

Does your facility have any specific mechanical ventilation guidelines or protocols for pediatric patients.

Thanks in advance,

Wade

Wade,
Since APRV is not based on Volumes and such the quidelines are the sames as for Adults. In simple terms: Use a Phigh that needed to create a MAP to oxygenate the patient (with out going over 30), Tlow to achieve a 50% of PEFR, Plow of zero, and a Thigh of 4-6 seconds or to create spontaneous breathing. Manipulations of these values for PaCO2 and PaO2 are the same.

Wade
Frawley PM. Habashi NM. Airway pressure release ventilation and pediatrics: theory and practice. [Review] [65 refs] [Journal Article. Review] Critical Care Nursing Clinics of North America. 16(3):337-48, viii, 2004 Sep.

Foland JA. Martin J. Novotny T. Super DM. Dyer RA. Mhanna MJ. Airway pressure release ventilation with a short release time in a child with acute respiratory distress syndrome. [Case Reports. Journal Article] Respiratory Care. 46(10):1019-23, 2001 Oct.

de Carvalho WB. Kopelman BI. Gurgueira GL. Bonassa J. [Airway pressure release in postoperative cardiac surgery in pediatric patients]. [Portuguese] [Journal Article] Revista Da Associacao Medica Brasileira. 46(2):166-73, 2000 Apr-Jun.
UI: 11022357

Thanks light!!!

Wade

Wade,
I posted some articles for you, that just now got posted. They were posted before your reply, but were just shown today, check out those articles.

Wade,

I would also suggest the following article:

Habashi. Other approaches to open-lung ventilation: Airway pressure release ventilation. Crit care Med 2005 Vol 33, No 3

He discusses start up and transitional settings for all patient ranges when utilizng APRV. Great explanation on how to set the Tlow and the advantages of spontaneous breathing.

Have you been using an Oscillator in these patients? APRV/Bi-Level can be an appropriate mode, but still cannot match the open lung capabilties of an Oscillator.

What evidence do you have Knighttherapist to make these claims?

What pressures is the occillator generating to create this open lung?