EMCrit Podcast EMCrit 335 - APRV for Lung Rescue Made Simple with Rory Spiegel
7 snips
Oct 21, 2022 
Rory Spiegel, an emergency and critical care physician known for ventilator strategy teaching, breaks down APRV/TCAV for lung rescue. He discusses when APRV is useful or harmful, ventilator choices, setting P‑high/T‑low/T‑high, effects on the heart and brain, and practical ED tips for early rescue and transition to CPAP.
AI Snips
Chapters
Transcript
Ventilator Choice Changes APRV Behavior
- Not all ventilators implement APRV equally; T-low control during patient effort is critical.
- Drager machines allow tight T-low control and low resistance to spontaneous breathing; Servos often auto-extend T-low and cause large release volumes.
Check For Single Lung Shunt Before APRV
- Identify shunt physiology before APRV; single‑lung shunt patients often hate PEEP and desaturate as PEEP increases.
- If a lung 'hates PEEP', reduce PEEP or recruit that lung (bronch, positioning) before APRV.
Avoid APRV For Primary Obstructive Exacerbations
- Avoid APRV as first choice for obstructive flares (asthma) unless ARDS coexistence justifies it.
- Obstructive patients decompensate quickly if ventilator settings are wrong and usually improve rapidly off the vent.