Mechanical Ventilation: PRVC Mode Overview
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Questions and Answers

What does PRVC stand for?

Pressure Regulated Volume Control

What are the settings for PRVC?

  • Target tidal volume, respiratory rate, inspiratory time, PEEP, FiO2, alarms (correct)
  • Target tidal volume, respiratory rate, inspiratory time, PEEP, FiO2, flow rate
  • Target tidal volume, respiratory rate, expiratory time, PEEP, FiO2, alarms
  • Target tidal volume, peak inspiratory pressure, inspiratory time, PEEP, FiO2, alarms

In PRVC, the ventilator automatically sets the target tidal volume based on patient conditions.

True (A)

What is the primary control element in PRVC?

<p>Pressure</p> Signup and view all the answers

What is the primary target in PRVC?

<p>Volume</p> Signup and view all the answers

Describe how PRVC delivers breaths.

<p>The first breath is volume controlled with plateau pressure. Subsequent breaths are pressure controlled based on the previous breath's plateau pressure. The ventilator measures volume after each breath to adjust the pressure to reach the target tidal volume.</p> Signup and view all the answers

What are the indicators for using PRVC?

<p>Patients requiring the lowest possible pressure with a guaranteed consistent tidal volume, patients with variable tidal volume, peak inspiratory pressure, or inspiratory time, patients with potential changes in lung compliance or airway resistance. (A), Patients requiring the lowest possible pressure with a guaranteed consistent tidal volume, patients with variable tidal volume, peak inspiratory pressure, or inspiratory time, patients with potential changes in lung compliance or airway resistance. (D)</p> Signup and view all the answers

What are some of the advantages of using PRVC?

<p>Maintains a minimal peak inspiratory pressure, ensures consistent tidal volume and minute ventilation, minimizes patient effort required for breathing, uses a decelerating flow waveform for better gas distribution, performs breath by breath analysis. (A), Maintains a minimal peak inspiratory pressure, ensures consistent tidal volume and minute ventilation, minimizes patient effort required for breathing, uses a decelerating flow waveform for better gas distribution, performs breath by breath analysis. (C)</p> Signup and view all the answers

How does PRVC respond to changes in lung compliance?

<p>If compliance decreases, the pressure is increased to maintain the target tidal volume until reaching the pressure limit.</p> Signup and view all the answers

What is VSV?

<p>Volume Support Ventilation</p> Signup and view all the answers

How is VSV similar to PRVC?

<p>Both modes are pressure-controlled and target volume. (A)</p> Signup and view all the answers

What is the primary difference between VSV and PRVC?

<p>VSV allows for spontaneous breathing, while PRVC does not. (C)</p> Signup and view all the answers

What role does the patient play in VSV?

<p>The patient triggers the breaths, but the ventilator provides pressure support to assist in reaching the set tidal volume.</p> Signup and view all the answers

What is the primary goal of VSV?

<p>To minimize patient work of breathing (C)</p> Signup and view all the answers

How does VSV compensate for changing patient needs during weaning?

<p>As patient condition improves, the patient needs less support. The ventilator reduces pressure support to encourage spontaneous breathing.</p> Signup and view all the answers

What is the primary aim of APRV?

<p>To recruit alveoli and prevent alveolar collapse (D)</p> Signup and view all the answers

Describe the pressure pattern in APRV.

<p>APRV uses two pressure levels: a high pressure (P-high) during inspiration and a lower pressure (P-low) during expiration.</p> Signup and view all the answers

APRV is a form of pressure-controlled ventilation.

<p>True (A)</p> Signup and view all the answers

How does APRV influence the I:E ratio?

<p>APRV uses an inverse I:E ratio where the inspiratory time is longer than the expiratory time.</p> Signup and view all the answers

Describe the role of P-high and P-low in APRV.

<p>P-high is the inspiratory pressure, typically set at around the plateau pressure. It helps to recruit alveoli and facilitate gas exchange. P-low is the expiratory pressure, usually set very low, to promote CO2 removal without derecruitment.</p> Signup and view all the answers

How does APRV contribute to preventing alveolar collapse?

<p>By creating intrinsic PEEP during the inspiratory phase (B)</p> Signup and view all the answers

How can APRV be used to correct respiratory acidosis?

<p>By increasing the P-high and T-low settings (B)</p> Signup and view all the answers

Explain the 'Drop and Stretch' technique for weaning APRV.

<p>The 'Drop and Stretch' technique involves gradually decreasing the P-high setting while simultaneously increasing the T-high setting, mimicking CPAP and reducing the dependence on the ventilator.</p> Signup and view all the answers

APRV is a proven rescue strategy for patients with ARDS.

<p>False (B)</p> Signup and view all the answers

What are some of the potential risks associated with APRV?

<p>High tidal volumes, increased transpulmonary pressures, higher risk of ventilator-induced lung injury (VILI) (A)</p> Signup and view all the answers

ASV is currently available on a wide range of ventilators.

<p>False (B)</p> Signup and view all the answers

What three main settings are used for ASV?

<p>Percent minute ventilation (%MinVol), PEEP, and FiO2 (C)</p> Signup and view all the answers

ASV's adaptive capabilities are based on real-time analysis of lung compliance, resistance, and patient effort.

<p>True (A)</p> Signup and view all the answers

What concept does ASV use to tailor ventilation?

<p>Time constants</p> Signup and view all the answers

How does ASV determine the optimal breath pattern?

<p>By mimicking the patient's natural breathing pattern under minimal effort (A)</p> Signup and view all the answers

How do the rules for changing PaO2 and PaCO2 change when using ASV?

<p>They remain the same, but the variables are adjusted to reflect the %MinVol setting (C)</p> Signup and view all the answers

ASV utilizes the C1V1 = C2V2 formula for adjusting ventilation.

<p>True (A)</p> Signup and view all the answers

Flashcards

Pressure Regulated Volume Control (PRVC)

A type of mechanical ventilation that uses pressure control to deliver a targeted tidal volume.

How PRVC works

The ventilator uses pressure to deliver a set tidal volume, adjusting flow on each breath to achieve the target.

PRVC with patient triggering

The ventilator uses pressure to deliver a set tidal volume, while allowing the patient to trigger breaths spontaneously.

Pressure limit in PRVC

The ventilator adjusts the pressure needed for each breath to reach the target tidal volume, preventing excessive pressure on the lungs.

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PRVC indications

PRVC is often used for patients with acute lung injury or ARDS, as it helps maintain a low peak inspiratory pressure.

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Time-cycled in PRVC

PRVC is a time-cycled mode of ventilation, meaning the inspiratory time is set, and the breath ends after that time.

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PRVC for variable compliance

PRVC is a commonly used mode for patients with variable lung compliance, as it helps maintain a consistent tidal volume even if compliance changes.

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PRVC advantage: Low PIP

One of the main advantages of PRVC mode is that it helps keep peak inspiratory pressure low, minimizing the risk of lung injury.

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PRVC advantage: Guaranteed VT and VE

PRVC provides a consistent tidal volume and minute ventilation, ensuring adequate gas exchange.

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PRVC advantage: Low WOB

In PRVC, patients typically experience low work of breathing, as the ventilator provides most of the respiratory effort.

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PRVC advantage: Improved gas distribution

Because of the decelerating flow in PRVC, gas distribution is more efficient, leading to better oxygenation.

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PRVC advantage: Breath by breath analysis

PRVC constantly measures and analyzes each breath, adjusting pressure to achieve the target tidal volume.

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PRVC: Impact of compliance changes

Changes in lung mechanics, such as increasing or decreasing compliance, impact the pressure needed to deliver the desired tidal volume.

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Volume Support Ventilation (VSV)

A type of mechanical ventilation that provides pressure support with a targeted tidal volume.

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Patient triggered in VSV

VSV is a spontaneous mode of ventilation, meaning the patient triggers breaths.

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How VSV works

VSV uses pressure support to assist the patient's breathing, with the ventilator adjusting pressure to achieve the target tidal volume.

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Variable tidal volume in VSV

In VSV, the tidal volume target is a minimum value, and patients can breathe higher volumes if needed.

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Pressure adjustment in VSV

The ventilator continuously adjusts the pressure support level to achieve the target tidal volume, reducing the pressure as the patient's condition improves.

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VSV: Patient-driven breaths

A mode of ventilation where the patient breathes spontaneously, with the ventilator providing pressure support to assist breathing.

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Airway Pressure Release Ventilation (APRV)

A form of mechanical ventilation that uses two levels of continuous positive airway pressure (CPAP) to improve lung recruitment and oxygenation.

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Inverse ratio ventilation in APRV

APRV uses inverse ratio ventilation, meaning the inspiratory time is longer than the expiratory time.

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APRV benefits: Higher MAP

APRV aims to maintain a higher mean airway pressure, which improves functional residual capacity (FRC) and alveolar recruitment.

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Spontaneous breathing in APRV

APRV allows patients to breathe spontaneously between mandatory breaths, promoting patient participation in ventilation.

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T-high and T-low in APRV

APRV uses two different inspiratory times: a longer time at the higher pressure (T-high) and a shorter time at the lower pressure (T-low).

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P-high in APRV

The higher pressure in APRV (P-high) is usually set near the plateau pressure, aiming to achieve optimal alveolar recruitment with minimal overdistention.

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P-low in APRV

The lower pressure in APRV (P-low) is set to a low level, typically between 0 and 5 cm H2O, to minimize alveolar collapse during expiration.

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Correcting imbalances in APRV

Adjustments to the APRV settings can be made to address respiratory acidosis or alkalosis by altering the inspiratory pressure and expiratory time.

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Weaning from APRV

Gradually reducing the P-high and increasing the T-high can help wean patients off APRV, mimicking the effects of CPAP.

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Adaptive Support Ventilation (ASV)

A mode of ventilation that dynamically adjusts the respiratory rate, tidal volume, and inspiratory time based on lung mechanics and patient effort.

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Time constants in ASV

ASV uses time constants, which represent how long it takes for a lung unit to fill or empty, to determine optimal breathing parameters.

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How ASV works: Minimizing WOB

ASV constantly adjusts breath parameters to minimize patient work of breathing, aiming to replicate the natural breathing pattern.

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ASV: Adjusting settings and blood gas levels

Changes in ASV settings, such as adjusting PEEP, FiO2, or %MinVol, affect blood gas levels (PaO2 and PaCO2) and should be used to achieve desired blood gas values.

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Using C1V1 = C2V2 in ASV

Yes, you can use the C1V1 = C2V2 formula to calculate ventilation changes in ASV by substituting %MinVol for either RR or Vt.

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Study Notes

Introduction to Mechanical Ventilation

  • Mechanical ventilation is a crucial intervention for patients with respiratory failure.
  • Different modes of ventilation exist, each with distinct characteristics and applications.

PRVC (Pressure Regulated Volume Control)

  • PRVC is a pressure-limited, time-cycled mode of ventilation.
  • It delivers breaths targeting a set tidal volume.
  • It's adjusted breath-by-breath to achieve the targeted volume.
  • Different ventilator brands have their own variations of PRVC mode (e.g. Hamilton: APV/CMV, CareFusion: PRVC).

PRVC Settings

  • Key parameters include target tidal volume, respiratory rate, inspiratory time, PEEP, and FiO2.
  • Alarms include high inspiratory pressure alarms that set pressure limits and limit excess pressure.

PRVC Taxonomy

  • Pressure controls the entire ventilation/control sequence.
  • Control modes (CMV or SIMV) are also part of PRVC modes which determine the breath sequence.
  • Adaptive modes (targeting scheme) allow for adjustment of ventilation settings between breaths, based on the patient's response, this is an automatic function of the ventilator.

PRVC Breath Delivery

  • The ventilator initially delivers a volume-controlled breath with a plateau pressure.
  • For all subsequent breaths, a pressure-controlled approach ensures the set tidal volume is met or kept within the limit.

VSV (Volume Support Ventilation)

  • VSV is similar to PRVC, but it's a spontaneous mode of ventilation.
  • This mode of ventilation is tailored to deliver pressure support to patients in spontaneous respiratory mode with a volume target.
  • It targets a specified volume by adjusting the pressure delivered to the patient.
  • The ventilator adjusts the pressure support breath-by-breath.
  • VSV is available on specific types of ventilators (e.g., Servo-I PB 840 VS; Drager V500 VS; SPN-CPAP/VS).

VSV Settings

  • Target tidal volume (Vt): Represents the minimum volume the patient can manually breathe, with higher volumes possible.
  • Parameters: Patient respiratory rate (RR), Inspiratory time, FiO2, PEEP, sensitivity (trigger).

APRV (Airway Pressure Release Ventilation)

  • It uses two CPAP pressures to improve oxygenation, recruit alveoli, and prevent alveolar collapse.
  • This mode uses inverse ratio ventilation (I:E), where inspiratory time is longer than expiratory time.
  • APRV increases mean airway pressure (MAP), FRC and alveolar recruitment.
  • This results in improvements in oxygenation.

APRV Settings

  • APRV utilizes two set pressures (P-high for inspiration, P-low for expiration).
  • Two corresponding inspiratory time settings (T-high, T-low) are used to determine the duration of the pressure phases.
  • T-high (inspiration time) setting is usually 3-5 seconds, and T-low (expiration time) is typically less than one second.
  • Pressure support is adjusted within the inspiratory time to maintain the minute ventilation.

APRV vs. BIPAP

  • APRV involves a longer inspiratory time than expiratory time.
  • APRV sets a limit on expiratory time.
  • APRV does involve a set respiratory rate (RR).
  • APRV prevents alveolar collapse by creating intrinsic PEEP.

ASV (Adaptive Support Ventilation)

  • ASV adjusts ventilator settings based on lung compliance, resistance, and patient effort.
  • Key parameters include respiratory rate (RR), tidal volume (Vt), and inspiratory time (Ti).
  • The ventilator continuously assesses the patient's breathing and adjusts settings.
  • ASV determines the optimal breathing pattern for the patient.
  • ASV is only available on Hamilton Ventilators

How to Make Changes (in all modes)

  • All ventilation modes follow basic rules for PaO2 (blood oxygen) and PaCO2 (blood carbon dioxide).
  • The percentage of minute ventilation (%MinVol) will affect PaCO2.

Example Cases

  • Case examples demonstrate specific scenarios (e.g., post-operative patient with a known lung disease and abnormal ABG values are presented) and how to adapt the respiratory settings.

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Introduction to Mechanical Ventilation (IMV Lesson 9)

Description

This quiz covers the essential aspects of mechanical ventilation with a focus on PRVC (Pressure Regulated Volume Control). It discusses the characteristics, settings, and taxonomy of PRVC to help learners understand this vital mode of respiratory support. Test your knowledge on how PRVC operates and its applications in clinical settings.

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