Airway Pressure Release Ventilation ( Aprv )

* Practicum Goal: * Prevent further complications in respiratory distress by educating the nurse on the use of CPAP and BiPAP to support the patient population with acute respiratory distress and other chronic respiratory illness.

“For some investigators, ‘weaning success’ is defined as sustained spontaneous, unassisted breathing with or without an artificial airway, and for others it is defined as sustained extubation” (Cook 2000). Whatever the nurse and physician see as the definition to weaning is far less important than ensuring their patient is weaned at the correct time. Allowing a patient to remain intubated and on mechanical ventilation when it is no longer needed, only puts the patient at risk for problems beyond the reason for initial intubation.

– Mechanical ventilation and positive end-expiratory pressure (PEEP) may compromise cardiac output and require modification of ventilator therapy (i.e., minimization of PEEP)

Airway management is a vital part of the job of an Emergency Medical Technician (EMT). The airway is the first thing an EMT must assess in all patients, with the exception of arterial bleeding. Improper, or lack thereof, management of the airway will kill a patient; therefore EMTs must master management of the airway, for fear of dire consequences if done incorrectly. The purpose of the airway is to remove carbon dioxide and transport oxygen to the blood.

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.

There are numerous different challenges that the paramedic will face in attempting to keep an airway patent. These challenges vary from patient to patient depending on their condition. One challenge in keeping a patent airway the paramedic will face is trying to maintain the airway of a trauma patient. Trauma patients make it difficult to maintain an airway due to the traumatic damage, especially if it has affected the face and neck regions.

Endotracheal tubes containing a tapered cuff have recently been approved by the United States Food and Drug Administration and, based on the findings from in vitro and in vivo studies, are believed to achieve a better tracheal seal (Bowton et al., 2013). This enhanced fit is suggested to reduce the passage of potentially contaminated secretions around the cuff and into the distal airway of mechanically ventilated patients, thereby decreasing the development of VAP. In a study executed by Bowton et al. (2013), researchers examined whether these tapered endotracheal tubes would be more effective in reducing actual rates of VAP. Their study utilized a two-period observational approach in which each study period took place over six of the same calendar months so as to eliminate potential variations in season related to VAP. All adults over the age of 18 who were admitted into a variety of specialized ICUs, whose VAP rates closely resembled the average of all ICUs in the United States, were included in the study. During the first six month period, all endotracheal tubes utilized by the facility contained the standard, barrel-shaped cuff. Following this period, an audit was performed to ensure that all of these tubes were removed and, subsequently, they were replaced with tapered-cuff endotracheal tubes. Additionally, all emergency medical

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

3. Teach patient effective ways to cough and breathe (deep breath, hold for 2 seconds and cough 3 times with their mouth open).

Sometimes when a patient is on the more common form of mechanical ventilation for an extended time or if the patient has undergone respiratory failure, their respiratory muscles have a tendency to become weak. With the use of this biphasic cuirass ventilation method they can have the opportunity to build and strengthen those muscles which, in return, can allow them to be weaned from the ventilator

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

Ventilator-associated pneumonia (VAP) remains a big drawback within the hospital setting, with terribly high morbidity, mortality, and cost. Some people tend to perform an evidence-based review of the literature that specializes in clinically relevant pharmacological and non-pharmacological interventions to prevent VAP. Thanks to the importance of this condition the implementation of preventive measures is predominant within the care of mechanically ventilated patients. There is proof that these measures decrease the incidence of VAP and improve outcomes within the intensive care unit. A multidisciplinary approach, continuing