Today, we speak about a mode of NIPPV that you should know about (but probably don't): Average Volume Assured Pressure Support (AVAPS).
Today's Guest, Alex Bracey (@BraceyA)
BIPAP Modes
99% of the time, the patient will wind up on:
BIPAP S/T-which allows the patient to breath spontaneously, but also has timed breaths–kind of an SIMV situation
my contention is that most patients with Type I resp failure should be on spontaneous CPAP.
Today we are talking about the mode we probably should be using for Type II resp. failure, namely:
Hypercapneic Encephalopathy Patients, Obesity hypoventilation syndrome patients, etc.
AVAPS
Average Volume Assured Pressure Support
this is essentially PRVC for NIPPV
Settings
- Vt – 8-10 mls/kg
- RR – probably start ~20 in the patients we are speaking about
- EPAP – whatever the patient needs for oxygenation, set low if pure Type II
- Max IPAP – 25 cmH20
- Min IPAP – EPAP + 4
- FiO2 – whatever you need
Papers
- Acet Öztürk, Nilüfer Aylin, Özge Aydın Güçlü, Ezgi Demirdöğen, Aslı Görek Dilektaşlı, Shahriyar Maharramov, Funda Coşkun, Esra Uzaslan, Ahmet Ursavaş, and Mehmet Karadağ. “AVAPS-NIV Treatment in Hypercapnic Respiratory Failure with Insufficient Response to Fixed-Level PS-NIV.” Tuberkuloz Ve Toraks 70, no. 4 (December 2022): 324–33. https://doi.org/10.5578/tt.20229603.
- Akbaş, Türkay, and Gülşah Altun. “Treatment of Critically Ill Patients with Acute Hypercarbic Respiratory Failure by Average Volume-Assured Pressure Support Mode.” The Clinical Respiratory Journal 15, no. 9 (September 2021): 973–82. https://doi.org/10.1111/crj.13401.
- Briones Claudett, Killen Harold, Monica Briones Claudett, Miguel Chung Sang Wong, Alberto Nuques Martinez, Ricardo Soto Espinoza, Mayra Montalvo, Antonio Esquinas Rodriguez, Gumersindo Gonzalez Diaz, and Michelle Grunauer Andrade. “Noninvasive Mechanical Ventilation with Average Volume Assured Pressure Support (AVAPS) in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnic Encephalopathy.” BMC Pulmonary Medicine 13 (March 12, 2013): 12. https://doi.org/10.1186/1471-2466-13-12.
- Gören, Nurfer Zehra, Emre Şancı, Feride Fulya Ercan Coşkun, Duygu Gürsoylu, and Başak Bayram. “Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial.” Balkan Medical Journal 38, no. 5 (September 2021): 265–71. https://doi.org/10.5152/balkanmedj.2021.20137.
- Yarrarapu, Siva Naga S., Hollie Saunders, and Devang Sanghavi. “Average Volume-Assured Pressure Support.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/NBK560600/.
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Nice episode guys. Definitely aware of AVAPS but never really maintained a patient on it. Yes essentially Non-Invasive PRVC. I’m wary of people using this ‘set it and forget it’ mode for the same reasons I am PRVC: patient wants ↑ support, but the machine gives less! “AVAPS Trap!”
Hi Scott,
Thanks for this episode. Is AVAPS a proprietary mode for Phillips V60s or will we expect to see AVAPS coming to Hamiltons/Dräger vents and the like?
I’ve personally not used it but it seems reasonable. As you say, if you’re titrating NIV well, I’d be uncertain as to whether it’ll make a big difference. But if it’s 10/5 and walk away, perhaps then.
Dean
vc-mmv with autoflow will get the job done on draeger
sure hamilton can do similar but someone will have to name mode
I believe AVAPS remains flow cycled while PRVC is time cycled.
I use AVAPS a couple of times a year in the ED and each time I wonder why I don’t use it more frequently.
not in front of a machine right now, but I’m pretty sure AVAPS has an I-time, just like PRVC
The I-time is applied to the mandatory breaths only
Thanks for for sharing knowledge,
I was researching what AVAPS is out of curiosity, at the right time i found this blog, with the satisfaction i’ve learnt some new today, hoping to get more valuable writing in future too.
Regards
Raghu
Analyst at Eleczo
Hey ! The article has help me in Research Thanks
Regards
Team Elecload India