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APRV, DuoPAP, BiPAP: Pro & Con… M Wysocki – March 2009. Plan. Definitions… Spontaneous ventilation is important… No evidences… Increasing complexity…. Definitions. L Rose, Intensive Care Med 2008. Definitions. L Rose, Intensive Care Med 2008. APRV: How it looks….
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Plan • Definitions… • Spontaneous ventilation is important… • No evidences… • Increasing complexity…
Definitions L Rose, Intensive Care Med 2008
Definitions L Rose, Intensive Care Med 2008
APRV… with versus without SB in pigs Wrigge H, Anesthesiology 2003
APRV w/o SB reduced Pigs Intestinal Blood Flow? Hering R, Anesthesiology 2003
APRV with SB better than PCV in polytrauma… Putensen C, Am J Respir Crit Care Med 2001
ASV with SB vs VC preserves diaphragmatic Funct° ASV VC Diaphragmatic function Duration of Mechanical Ventilation Jung B, SRLF 2009
APRV: Where are the clinical evidences? • Valentine – Am Respir Resp Dis 1991: Cross Over study • Räsänen – Crit Care Med 1991: Cross Over study • Davis – Arch Surg 1993: Short term physiologic study • Sydow – Am J Respir Crit Care Med 1994: Short term physiologic study • Putensen - Am J Respir Crit Care Med 1999: Cross Over study • Putensen - Am J Respir Crit Care Med 2001: n = 30 APRV vs PCV (cf slide before) • Hering – Intensive Care Med 2002: Cross Over study • Varpula – Acta Anesthesiol Scand 2003: Short term w/wo prone • Varpula - Acta Anesthesiol Scand 2004: n = 58; SIMV vs APRV – equivalent • Uyar – Anaesth Intensive Care 2005: n = 20: PSV vs APRV - equivalent
APRV: how to make your life complex… 9 settings!!!
APRV: CONCLUSIONS • Spontaneous breathing is important… • APRV – DuoPAP – BIPAP are: • Complex • Dangerous • No evidence showing the opposite… « What’s difficult is to make things easier »
