APRV: Setting P-High based on the Static Pressure Volume Curve

Some newer mechanical ventilators provide the operator with automated tools to obtain a static Pressure Volume (P/V) Curve in the ventilated patient. These tools provide the clinician a simple, safe, and reproducible method to assess the P/V curve for various pulmonary conditions. 

Photo 1: Hamilton G5 ventilator screen, showing the "P/V tool" software to obtain a static P/V curve.

The Constant Low Flow Method: Utilizing the PB840 part two (video)

Additional Reading:

The Acute Effectiveness & Safety of the Constant-Flow, P/V Curve to Improve Hypoxemia in ALI.

Identifying Optimal PEEP with the PB 840 Ventilator: the "Constant Low Flow Method"

Evaluating the Pressure/Volume curve for the lower inflection point, provides the operator a idea of where to appropriately set the level of PEEP. The curve identifies where lung recruitment begins and at what pressure/volume creates over distention and/or injury.

In newer generation ventilators (Draeger's Evita XL or Hamilton's Galileo or G5 platforms) obtaining the static pressure/volume curve at a low flow state is simple via the machines automated tools.

Conversely, in other ventilators obtaining a static low flow P/V curve can be complicated if not impossible to perform.

The PB 840 does not have a automated tool for performing a "Low Flow" maneuver, however the practitioner can do the maneuver manually using the following steps (1):

The "ASV Target Point": Adjusting the %MinVol setting During Adaptive Support Ventilation

After a few years of implementing Adaptive Support Ventilation (ASV), I still receive questions from staff members and physicians regarding the ideal %MinVol target setting when initially setting-up ASV. I usually respond by asking, “do you want to wean or rest the patient”?

Shook to Death: a Case Study of High-Frequency Chest Wall Compression

Background

There are a variety of techniques used as "Chest Physical Therapy" (CPT), for patients with airway diseases. The main goal of these therapies is to augment secretion mobilization & airway clearance[1].

One of these techniques utilizes high-frequency chest wall compression a.k.a "The Vest" (® Hill-Rom). The manufacturers of the Vest list numerous conditions that the device may be used for, from patients with chronic respiratory conditions-to-Acute Respiratory Distress Syndrome[2].

Conversely, there are no contra-indications, considerations when not to use the device, or patients that may be at risk listed in the product information.