I am a lead respiratory therapist and when we get new employees, APRV is always an intimidating mode of ventilation. Now, with your beautiful video, it no longer has to be, and I absolutely love the dropping and stretching to wean the patients just brilliant.
RRT here, gotta say this was a great review on APRV. Hospitals I work at don’t use this mode enough so when I actually do get to use it it’s nice to have a refresher. Great video!
You did such a great Job I’ve been a therapist for almost 8 years and never heard or seen someone break it down so well thank you again!!!! And You’re father in law would be proud!!!!
APRV is recommended for spontaneously breathing pts. Permissive Hypercania is allowed to prevent Ventilator Induced Lung Injury(VILI). Increasing the I-time will cause pts to retain CO2. Paralyzed and sedated pts will have no respiratory drive and trigger no spontaneous breaths. Otherwise excellent video. Thank you for this.
Jessica Bunin I was Associate Clinical Professor for IM residency program in GA for 7yrs as Hosptialist. Now working for VA system in Nevada. But I also teaching residents as well.
Just wow wow wow! Please don’t stop posting keep educating now. I binged watch your videos over and over..I’m so happy I came across your channel..you explain things so well!!!!!!
This is such a wonderful session am a recently graduated Anaesthesiologist from Tanzania and here we also double-down as intensivists and I have always had unpalatable times understanding that mode...kudos.👌🏿
Thank you so much RRT here also been traveling during this crisis and been working with APRV but I’m back at my home hospital now and I’m being told not to use it because the physician don’t understand it hope this vid will help them try at least AC/PC correctly to try to save some of these patients
2 part question here..Does APRV mode recommended to use for pts that are prone and paralyze induced? If permissive hypercapnia is acceptable and Phigh is already set to 30 but low Vte returned will you switch pts back to ACPC?
Great teaching . U commented that one can add pressure support to help patient breath spontaneously...if I got u correct ...1)should it be done routinely 2)how much support usually 3)need to add this support to p high...so that it remains below 30?? Thanks great teaching
nitin Kanwar I do it routinely if my pressures allow. As you pointed out, the total must remain less than 30, so I try to give PS of 5 if I can. Thanks for watching!
So sorry about your father in law. Thank you for this video. Just one doubt, could u pls explain how u calculated that I:E ratio as 9:1? I didn’t quite get that. Sorry
Patient is spending 4.5 seconds for inspiration (Thigh) and 0.5 seconds for expiration (Tlow) which is a ratio of 4.5:0.5. And since ratios don’t have decimals (usually) you multiply both sides of the ratio by 2 to make it 9:1.
@@mbel5694 the goal of the ratio is to make it a whole number. So not always 2 it depends on what you set the Tlow to. Just have to get it to be a whole number.
Today my patient reached the maximum setting on ACPC mode which is (45P- 18peep-40RR-100fio2) and I decided to try the last card..APRV, pray for my patient my god help me
Inverse ratio ventilation you are using causes Auto-Peep .You have to give paralytic and sedatíon.and this much inverse ratio .May also decrease Blood pressure.Kindly explain?How is it possible this much inverse ratio
I am a lead respiratory therapist and when we get new employees, APRV is always an intimidating mode of ventilation. Now, with your beautiful video, it no longer has to be, and I absolutely love the dropping and stretching to wean the patients just brilliant.
Amazing ! ER doctor here starting Surgical ICU tomorrow. Needed the review ! May he rest in peace ! COVID sucks !
RRT here, gotta say this was a great review on APRV. Hospitals I work at don’t use this mode enough so when I actually do get to use it it’s nice to have a refresher. Great video!
You did such a great Job I’ve been a therapist for almost 8 years and never heard or seen someone break it down so well thank you again!!!! And You’re father in law would be proud!!!!
APRV is recommended for spontaneously breathing pts. Permissive Hypercania is allowed to prevent Ventilator Induced Lung Injury(VILI). Increasing the I-time will cause pts to retain CO2. Paralyzed and sedated pts will have no respiratory drive and trigger no spontaneous breaths. Otherwise excellent video. Thank you for this.
Condolences to you and your families! These are some of best basic Vent lectures that I have seen. I encourage my interns n residents to watch them.
Thank you so much for saying that. You made my weekend! Just curious, where are you from?
Jessica Bunin I was Associate Clinical Professor for IM residency program in GA for 7yrs as Hosptialist. Now working for VA system in Nevada. But I also teaching residents as well.
Just wow wow wow! Please don’t stop posting keep educating now. I binged watch your videos over and over..I’m so happy I came across your channel..you explain things so well!!!!!!
I was so involved in this beautiful explanation that I said thank you at the end of as if I was in the room
Well you, my friend, are very welcome!!! I am touched by and appreciative of your message!!
Hahahaha me too!!!
This is such a wonderful session am a recently graduated Anaesthesiologist from Tanzania and here we also double-down as intensivists and I have always had unpalatable times understanding that mode...kudos.👌🏿
As a respiratory therapist this is very good and easy to understand about APRV!
Awesome job! I just retired from the Army last week, and it was oddly refreshing to hear her say Hooah😁
I’m so sorry to hear about your father-in-law❤️
My deepest Condolences for the lose of your father in Law, may his soul Rest In Peace
So sorry for your loss!
Very informative video. Please keep sharing and educating us.
Thank you so much RRT here also been traveling during this crisis and been working with APRV but I’m back at my home hospital now and I’m being told not to use it because the physician don’t understand it hope this vid will help them try at least AC/PC correctly to try to save some of these patients
I'm so sorry for your loss...
Great job explaining this.
Thank you mam 😊
This mode is crystal clear now
Thank you from Malaysia 👍🏻
Wonderful Jessica 🌷🌷
Very well explained.thank you.
You are awesome !
Awesome video!
This is so helpful. Thank you so much!!!
2 part question here..Does APRV mode recommended to use for pts that are prone and paralyze induced? If permissive hypercapnia is acceptable and Phigh is already set to 30 but low Vte returned will you switch pts back to ACPC?
Thank you so much!
Thank you.
Helpful
rest in peace hero
Thank you so much
it was wonderful lecture thank you , but what about permissive hypercapnia limit and how to correct
Thanx ❤️
I came here to learn about APRV. Started with some feels.
Well done
❤
Great teaching
. U commented that one can add pressure support to help patient breath spontaneously...if I got u correct ...1)should it be done routinely
2)how much support usually
3)need to add this support to p high...so that it remains below 30??
Thanks great teaching
nitin Kanwar I do it routinely if my pressures allow. As you pointed out, the total must remain less than 30, so I try to give PS of 5 if I can. Thanks for watching!
How you calculate I:E 9:1?
So sorry about your father in law. Thank you for this video. Just one doubt, could u pls explain how u calculated that I:E ratio as 9:1? I didn’t quite get that. Sorry
Patient is spending 4.5 seconds for inspiration (Thigh) and 0.5 seconds for expiration (Tlow) which is a ratio of 4.5:0.5. And since ratios don’t have decimals (usually) you multiply both sides of the ratio by 2 to make it 9:1.
Shud we always multiply by 2 for this reason?
@@mbel5694 the goal of the ratio is to make it a whole number. So not always 2 it depends on what you set the Tlow to. Just have to get it to be a whole number.
Why the P low has to be at 0 and why can't we keep it at 5. Wouldn't that lead to more recruitment of the alveoli??
Today my patient reached the maximum setting on ACPC mode which is (45P- 18peep-40RR-100fio2) and I decided to try the last card..APRV, pray for my patient my god help me
Decrease T-high to improve high PaCO2. Never increase T-low to 1sec as it would drop peep to zero.
Tenzin Gelek Yeah talk about derecruitment
Inverse ratio ventilation you are using causes Auto-Peep .You have to give paralytic and sedatíon.and this much inverse ratio .May also decrease Blood pressure.Kindly explain?How is it possible this much inverse ratio
why is the I:E ratio is 9:1?
4.5/.5 = 9 gives you an inverse ratio of 9:1
Died last week because he caring for his patients who had covid? Seriously blaming it on your patients? Damn
Continue doing the great work
Regards ,
Dr. Jaspreet singh MD