Respiratory Therapy APRV vs BiLevel

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[JB-cgrn]

I can’t thank you enough for all your videos. This makes total sense finally

[Hello]

Hi respiratory coach! I’m a current RRT of 2+ years and still find your videos to be super useful in further enhancing my skills to benefit my patients to the best of my ability! Thankyou!! Was wondering if you could talk about the advanced settings during the use of APRV, specifically on the Avea- (T sync High and T sync low % settings) the hospital I work at likes to have these set at 10%. Could you explain what it does and how changing it affects the patient?

[deanhealy]

Very good explanation of APRV and Bi-Level modes.

[jiaelee]

Thank you so much! It was so difficult for me to understand what the Bi-livel is and how it's working. This lecture video is really amazing and awesome! Very easy to understand. Really appreciate it! 👍👍👍👍👍

[ajaytomy]

Thank you very much sir, all your video's are outstanding.

[chebej]

One of the best talks about the mode comparisons I've heard. Thank you!!

[johnnybravo]

I think APRV is good with Pressure control modes with helping expand body surface area of AC (Alveolar Capillary) membrane and then use Bilevel for Volume control AC mode.

[AlreadyAJD]

What i found the most wonderful about your method, is that you thoroughly clear everyone's doubt in the comment section! wonderful supplementation to this nice video! great work sir. learning so much from u.

[Redfeather]

Working with the Maquet Servo U’s right now.

[elisefine]

Hello! We are learning about APRV and the advanced modes now in class. Can you explain the difference between an active or an open exhalation valve?

[adrianevans]

Wow, awesome video, explanation and easy to follow 👍

[hollieburger]

still struggling to understand everything about APRV/BILEVEL. Can you do pt scenarios on the ventilator for us?

[futurerustic]

Hi Coach, thanks for everything you do. I am at a school with a truly horrible MV instructor, so after every class I rush to your channel to actually learn the material.

My question on APRV is, if the pressure only drops for that brief moment, how does the patient actually exhale properly? Isn't the high pressure maintaining their alveoli in an open position? Or is it that they're actually taking breaths during the hi pressure phase (in which case they have a spontaneous RR?)

Thanks in advance!

[paytenbaughey]

I'm in my second year of RT school and my teacher is making my clinical partner and I do our research project on "Bilevel". She also said "you should be researching bilevel and APRV". I have no freaking clue..lol

[ajt]

How do you decide if u have to switch a pt from a VC/pC mode to APRV to optimize pt status? What could be some scenarios ?

[kmssd]

Thank you so much for quick response and explaining ❤️👍🏼

[janvanlandeghem]

Aprv seems bilivel with inversed ratio? (so longer Thigh and shorter Tlow)? What about Co2 build up in that mode? Seems a lot inhaling and very short exhaling (if patiënt is fully sedated)

[thatthiskitchen]

Respiratory Coach, as usual I love your explanation. I wish I had watched this before the last night. I had one of my COVID-19 patients on APRV last night and it was my fist APRV patient. He was in a bad shape, nothing was working for him and they decided to try APRV. I was received him on APRV, P high 30, P low 0, T high 6.5 and T low 0.4. and I know what you think, yes it was 0.4. He was on 60%, somewhat sedated on Dragger 500. He was breathing 22/23. I noticed that his SpO2 was decreasing and ETCO2 was increasing. Because of the concern did an ABG. PO2 was 74 PO2 was 56. Only 2 increase of CO2 and almost the same PO2. Even though, I wanted changes, covering .... did not want to make any change. Later, I had to increase FiO2 even to 80% to maintain his >92%. At one point his ETCO2 was outrageous and increased to high 80s, and I even to low 90s. Did an ABG again and pH 7.16, PCO2 was 87, and PO2 was 54. At that point, I increased P high to 32 to and to 35, decreased T high to 5 secs and increased T low to 0.5 secs. I was able to bring down ETCO2. Did an ABG PO2 was 80. That was the time to turn over my assignment, luckily he was a more experienced therapist; I was glad and by the time I was leaving I saw ETCO2 was reading in high 60s to low 70s. I wish I got the risk of changing numbers earlier but I was not confident on making those changes. But I am proud that I am a better therapist than yesterday. (By the way, my changes were approved later.) My questions are, 1. What was the best thing for me to do to reverse the situation. 2. If it was not the end of the shift, what could have I done further. 3. Will you be able to do a video explaining on maintaining this kind of patients on APRV please.

[colintaylor]

Should patients be heavily sedated on APRV mode? And do users need to worry much about risk of breath stacking?

[huyproluvthanh]

Thanks for a very informative video.
I have a few questions:
1. To fix the low PaO2, do you change I:E ratio (T-high) or do you change P-High or P-low? I have been seeing some RTs And Docs raise peep low (or P-Low) to 14-16 to fix PaO2.
2. Are we allowing permissive hypercabnic for patient on APRV? if we want to correct PCo2, what is the first parameter you world change between RR or P-high to change the minute volume?
3. What is an appropriate weaning guide for patient on APRV? Should we switch them straight to conventional mode before TSB patient?

Thanks again!