doctor.phil
New Member
Total Posts: 1
Joined: July 2010
From: Media, PA
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Posted: July 01 2010 5:52 PM 
If a patient develops a condition which requires surgery, and the surgical requirements include paralysis, what is the proper ventilator mode for an APRV-dependent patient with Phigh above, say, 30?
The issues include, but are not limited to:
--Loss of recruited alveoli caused by interruption of high Mean Airway Pressures.
--Loss of recruited alveoli if Plow (often zero at my institution) effectively becomes PEEP once neuromuscular blockade is instituted and the ventilator mode remains APRV.
--Isn't APRV in a paralyzed patient simply high volume/low PEEP? Hasn't ARDS-net protocols replaced this combination?
--Sudden changes in PEEP to compensate may dramatically alter hemodynamics
--last, and perhaps not least, "ownership" issues between services.
In addition, has anyone seen surgical disasters in patients with open abdomen and APRV? Any eviscerations seen a*sociated with imperfect sedation or dramatic coughing episodes?
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