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PRVC Mode Workshop. Objectives. Understand the dual control concept Understand the pressure regulation mechanism in PRVC Demonstration of PRVC Settings and adjustment with Servo i and Dragger Indications, advantages and disadvantages. Volume vs Pressure Control. Dual Control Concept.

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objectives
Objectives
  • Understand the dual control concept
  • Understand the pressure regulation mechanism in PRVC
  • Demonstration of PRVC
  • Settings and adjustment with Servo i and Dragger
  • Indications, advantages and disadvantages
volume vs pressure control
Volume vs Pressure Control

Dual Control Concept

volume control
Volume Control

Higher Pressure

Decreased Compliance

Maintained VT

pressure control
Pressure Control

Same Pressure

Decreased Compliance

Lower VT

prvc automatically adjusts to compliance changes
PRVC Automatically Adjusts To Compliance Changes

Pressure control Ventilation

PRVC

slide9
PRVC
  • Assist-control ventilation
  • Pressure control titrated to a set tidal volume
  • Time cycled
assist control
Assist control
  • Breaths:
    • Ventilator initiated (control breaths)
    • Patient initiated (assist breaths)
    • Set minimum frequency
  • Characteristics of each inspiration are the same
    • Not affected by whether breath is control breath or an assist breath
assist control1
Assist control
  • Set
    • Minimum respiratory rate
      • Patient’s spontaneous respiratory rate < set rate  ventilator gives additional control breaths to make up difference
      • Patient’s spontaneous rate > set rate  no control breaths
slide12
PRVC
  • Set
    • Minimum respiratory rate
    • Target tidal volume
slide13
PRVC

Test breath

Measure VT

Compare

to set VT

More

Less

Equal

 inspiratorypressure

Same inspiratorypressure

 inspiratorypressure

slide14
PRVC
  • Set
    • Minimum respiratory rate
    • Target tidal volume
    • Upper pressure limit:
      • Maximum delivered pressure = 5 cm H2O below pressure alarm limit
    • FIO2
    • Inspiratory time or I:E ratio
    • Rise time
    • PEEP
dual control breath to breath pressure regulated volume control
Dual Control Breath-to-BreathPressure Regulated Volume Control

Pressure-limited Time-cycled Ventilation

prvc pressure regulated volume control
PRVC (Pressure Regulated Volume Control)

Upper Pressure Limit

Pressure

5 cm H2O

Time

5

4

6

3

2

1

Floe

Time

PRVC. (1), Test breath (5 cm H2O); (2) pressure is increased to deliver set volume; (3), maximum available pressure; (4), breath delivered at preset E, at preset f, and during preset TI; (5), when VT corresponds to set value, pressure remains constant; (6), if preset volume increases, pressure decreases; the ventilator continually monitors and adapts to the patient’s needs

slide17

yes

Volume from

Ventilator=

Set tidal volume

no

Calculate

compliance

Calculate new

Pressure limit

Time= set

Inspiratory time

yes

Trigger

Pressure limit

Based on VT/C

Cycle off

no

Control logic for pressure-regulated volume control and autoflow

slide18
PRVC

The Mode on Different Ventilators

prvc in servo i
PRVC in Servo i

Pressure

Flow

Volume

slide20
PRVC

Upper Pressure limit

5 cm H2O

Pressure

Flow

Volume

slide24
PRVC

Indications, Advantages and Disadvantages

advantages
Advantages
  • Decelerating inspiratory flow pattern
  • Pressure automatically adjusted for changes in compliance and resistance within a set range
    • Tidal volume guaranteed
    • Limits volutrauma
    • Prevents hypoventilation
disadvantages
Disadvantages
  • Pressure delivered is dependent on tidal volume achieved on last breath
    • Intermittent patient effort  variable tidal volumes
  • Less suitable for patients with asthma or COPD
prvc pressure regulated volume control1
PRVC (Pressure Regulated Volume Control)

Disadvantages and Risks

Afvantages

Maintains a minimum PIP

Guaranteed VT

Patient has very little WOB requirement

Allows patient control of respiratory rate

Decelerating flow waveform for improved gas distribution

Breath by breath analysis

  • Varying mean airway pressure
  • May cause or worsen auto-PEEP
  • When patient demand is increased, pressure level may diminish when support is needed
  • May be tolerated poorly in awake non-sedated patients
  • A sudden increase in respiratory rate and demand may result in a decrease in ventilator support