We do not have an Oscillator available. We only have Servo i's and 840's. Our childrens hospital lost their trauma validation and we will be keeping these kids. We were used to stabilze and transport...not anymore. Thanks for the replies so far! Wade
Originally posted by Knightherapist: 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.
I would actually disagree with this statement totally and say that APRV would provide more open lung capabilities (recruitment) than Oscillation. I am basing this on the fact of the patients ability to spontaneous breath. Our NICU has actually done away with HFO and gone with a complete APRV policy.
I would have to Completly disagree with HFOV recruitment being better. A spontaniously breathing lung ALWAYS recruits better. This is the reason Stocks and Downs pioneered this mode and Habashi perfected it. I'm not saying that HFOV is dead by any means. This mode of Ventilation still has a place in Adult and Pedi/Neo, it's just not used as much any more due to the advances in Pulmonary Research across the country. With the addition of NAVA (Neurally Adjusted Ventilatory Assist) we may see a whole swing in the way we care for all ventilated patients across the board.
I would actually disagree with this statement totally and say that APRV would provide more open lung capabilities (recruitment) than Oscillation. I am basing this on the fact of the patients ability to spontaneous breath. Our NICU has actually done away with HFO and gone with a complete APRV policy.
Brandx- I am curious about this statement- why would a patient not be able to breath spontaneously from an oscillator? We do it all of the time. The oscillator offers a continous gas source to breath off of.
Unloading work of breathing during high-frequency oscillatory ventilation: a bench study Marc van Heerde1
Critical Care 2006, 10:R103
Contrary to your statment; the bias flow actually has been the biggest cause of imposed work of breathing in previous studies and researchers are examining demand flow systems to allow for spntaneous breathing during HFOV.
I found this to be an interesting read, a study done in Toronto regarding HFOV in adult ARDS. In resonse to knights plea for HFOV. It would seem there are no studies comparing APRV to HFOV just yet. Regarding conventional mc vent modes and HFOV though has not as yet shown significant improvement in mortality. As far as efficacy this study found HFOV to be an effective and safe was to increase MAP. As far as opening a lung and keeping it open it seems to be a useful tool. I am keen to try the APRV approach as well. My only experience in use in ICU was limited by my inexperience with the mode. Would you recommend a definate protocol? Do you perform an open lung technique prior to use of the mode, how do you determine optimal PEEP, graphics, how do you do it?
Here is the article on HFOV, it is an adult study:
High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med. 2002 Sep 15;166(6):801-8. PMID: 12231488 [PubMed - indexed for MEDLINE]
FIN, Check out ICON, intensivecareonline.com they have a great protocal for running APRV that was develope by Dr. Habashi.
There is no need for a recruitment manuever before implementing APRV becasue APRV in itself is like a continous recruitment manuever.
There are only four settings in APRV (in reality three) Phigh, Thigh, Plow, Tlow.
you set the Phigh to your Pause pressure of conventional ventilation, your Thigh to 4-6 seconds, Tlow to 25-75% of PEFR and your Plow at Zero. Since your Plow is Zero this realy only leaves the first three. After setting these three parameters you will need to start increasing your Thigh untill the patient begins to breath spontaneously at this point you are done. Now just monitor your Tlow becasue as you recruit your patients lungs open the expiratory flow characteristics will change and you might have to tweek the Tlow.
This mode is a great mode that has many article on it showing benifits for ARDS patins, Cardiac complrimised patients, pediatrics, and now some are using it more and more in the neonatal world.
Light
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004
