Nuts & bolts
Apneic ventilation using a BiPAP machine with Spontaneous/Timed mode (S/T Mode)
Transitioning from spontaneous breathing to machine-triggered ventilation
Keep the airway open
Machine settings to optimize oxygenation
Physiology of recruitment: Understanding transpulmonary pressure
How to set the BiPAP machine during apnea to optimize trans-pulmonary pressure
Machine settings to optimize ventilation
Safety and maximal peak pressure
Advantages of pressure-limited ventilation
Pressure-limited ventilation guarantees a safe inspiratory pressure.
Pressure-limited ventilation maximizes the efficiency of inspiration.
When should apneic ventilation be considered?
- Ventilatory support up until the moment of intubation may be easily provided using more sophisticated BiPAP machines (which can be set to provide backup respirations as soon as the patient stops breathing) or a mechanical ventilator.
- Continuing ventilator support until intubation improves oxygenation and ventilation during paralysis. This may be useful for patients at high risk of hypoxemia (due to lung collapse) or acidosis (due to metabolic acidosis).
- Expert mask-ventilation technique is critical to maintain an open airway after paralysis.
- Use of pressure-limited ventilation during apnea guarantees avoidance of high inspiratory pressures that could cause gastric distension and aspiration.
- Patients with hypoxemia may benefit more from PEEP, whereas patients at risk from hypercapnia may benefit more from higher driving pressures. The following is a rough guide to setting up apneic ventilation for different types of patients:
- PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0) - April 2, 2020
- PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong. - March 29, 2020
- PulmCrit- Is Lopinavir/Ritonavir down and out? - March 19, 2020