More on EMCrit
- EMCrit Wee – The Philosophy of APRV – TCAV with Nader Habashi
- EMCrit 270 – COVID19 Respiratory Rescue and Ventilatory Optimization – Airway Pressure Release Ventilation (APRV) Time-Controlled Adaptive Ventilation
- PulmCrit- APRV: Resurrection of the open-lung strategy?
Over the last 5 years, every consult I have had for V-V ECMO due to ARDS has been on ARDSnet regimen, most paralyzed, deeply sedated, and requiring pressors. We have used APRV to avoid ECMO in almost all cases when not already dying or in extremis from hypoxemia (pO2 in 30s) so that we have only cannulated 1 out of every 5 consults (~22%) and have an 80% survival rate (this data includes COVID-19 as well as trauma patients whose families withdrew care due to severe TBI despite excellent lung recovery). Our actual “failure rate” of APRV – meaning it… Read more »
Interesting experience. I have great success with APRV & ARDS, just not in COVID19.
Covid patient will initially respond well (most patients usually respond well initially to APRV if they have recruitable lungs and RV function is ok), but eventually COVID patients will continue to deteriorate and APRV will fail.
Severe Covid ARDS mortality is VERY high (VC, APRV or ECMO). APRV didn’t work for these patients and most got pneumomediastinum and pneumothoraces.
But the reality is that the evidence is kinda of a mixed bag for APRV and ARDS with the exception of the Chinese study.