RT Clinic : AVAPS Explained

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Күн бұрын

Thanks for watching the RT Clinic!
AVAPS (average volume, assured pressure support) is a new mode of non-invasive ventilation. The titration of IPAP to reach a target Vt is key to keeping the patient properly ventilated and comfortable.
If this series is helpful, please comment below!
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Пікірлер: 50

@Playbackrm100 2 ай бұрын

Very, Very Good Job!! This should have over 100K Views.

@JT-408 4 жыл бұрын

Awesome information, thank you for explaining it to us.

@rt.asmaalshammari 4 жыл бұрын

Thank you so much!! This video came on time 👍

@CS-bh4ur 3 жыл бұрын

Thanks so much!!!

@gardengrower7633 Жыл бұрын

Wonderful explanation - thank you

@beverlystilwell5472 Жыл бұрын

Thank you so much for all your videos. You do an awesome job! Would love see an in dept educational about the Flight 60...Hint Hint.

@meteorman6167 2 жыл бұрын

Basically, you set a target volume. The patient should be spontaneously breathing. When they do, the vent will adjust the pressure support in the background to guarantee that target volume. if the patient can only pull in 300ml, the vent will push extra support to get to the target 500ml.

@rtclinic 2 жыл бұрын

Exactly and the extra pressure support will stop at the high pressure setting. The v60 will alarm at that point and let you know it can't hit the guaranteed volume.

@santaclause3487 Жыл бұрын

@@rtclinic do u have to have an exhalation leak on these if using as a closed system with a trach? I see ur supposed to if using for NIV. I ask cause I left a patient on all night with it closed using it on their trach with cuff inflated. I ran an ABG in AM and CO2 was great when I realized it’s probably supposed to be open.

@olgaverito827 4 жыл бұрын

how about invasive ? for intubated patient ( chronic Vent)

@mikewathen299 4 жыл бұрын

When you initiate AVAPS is it ok to just keep turning up your min and max P until you reach your your target Vt, and then just back min P back off? It seems to take a long time for the machine to reach target Vt sometimes. Also, when do you think AVAPS is the better mode to use vs S/T? Thanks

@rtclinic 4 жыл бұрын

Mike, That is a great option to transition from S/T to AVAPS. I think AVAPS is much better to manage transient hypoventilation related to obesity or advanced lung disease, especially during sleep/naps. AVAPS is also good for those anxious patients that have difficulty tolerating BiPAP. S/T is best to manage acute respiratory acidosis! Great question!!

@mitchkrdr 3 жыл бұрын

Hello! Thank you for this helpful info! If I may ask, so if the patient is tachypneic, how does it affect the augmentation of the tidal volume given that you have a set rate. I hope it makes sense what I'm trying to ask. It just confuses me how we set a rate when the patient has to be spontaneously breathing on this mode. Thank you and I look forward to hearing from you

@rtclinic 3 жыл бұрын

The rate should be used only as a warning that the patient is breathing slowly. The v60 will alarm if the patient is breathing exactly with the set rate. It is alot different that a set rate on invasive ventilation.

@mitchkrdr 3 жыл бұрын

@@rtclinic Thank you Jimmy! I love your videos and so grateful for sharing them! God bless you more!

@chelysgarage1457 Ай бұрын

how do you determine your expiratory time on the avaps. Do you just calculate your tct? I just find it out there is no I:E ratio displayed compared to other Philip NIV machines

@rtclinic Ай бұрын

Exp time will be somewhat variable based upon the patient. That is one of the best attributes of AVAPS, it moves with the patients needs. But to get the actual Exp time you'll need to subtract the Itime from the TCT. You are on the right track!

@ronnieshearouse1143 3 жыл бұрын

thank you so much for your videos

@siwenstokes5930 3 жыл бұрын

Say the goal of tidal volume set by the machine is 380 like you illustrated. What does it mean when pt's tidal volume to be way higher, say 800, and the alarm is going off? How to trouble shoot that? Thank you!

@rtclinic 3 жыл бұрын

It sounds like you need to lower the minimum IPAP.

@siwenstokes5930 3 жыл бұрын

@@rtclinic Thank you!

@rolandwoltman7835 3 жыл бұрын

@@rtclinic Or Jimmie, It sounds to me like you are using AVAPS on a patient with an acute VQ mismatch (or BiPAP on metabolic acidosis) . This is dangerous. Especially if the patient is already fatigued. Air hungry patient + AVAPS = intubation

@mamasheep6425 3 жыл бұрын

Thanks for the video! Quick question, the "average" in AVAPS is an average of how many past breaths? Since you say it takes time to adjust it must be an average of quite a number of breaths I'm guessing, no?

@rtclinic 3 жыл бұрын

I dont want to guess. Let me look it up and I'll let you know.

@rtclinic 3 жыл бұрын

It takes the average Vt over one minute and adjusts the IPAP every minute to try to reach the desired Vt

@janvanlandeghem9749 3 ай бұрын

Augmenting with 2,5 cm per minute

@rajnbull 2 жыл бұрын

I am a 55 year old male that was diagnosed with COP D and asthma from 911. I am recently getting more attacks that are more related to COP D and get me in the ER where I'm very close to be intubated. Now there is a multiple of problems one the area where I live is extremely dry and windy in Texas Lubbock. 2 the problem is allergies and a very high. All these things are playing a role in ticketing to me and getting my lungs to over Excite is site or Exacerbate The situation massivelyIn your opinion what would be the best machine for me and can I use oxygen with this type of machine. Right now my pulse ox Is ranging around around 87 or 83 it doesn't stay there once a month oxygen but it is a problem. I hope you get this message very soon to help me decide. My Pulmonologist It's extremely hard to get to and not very friendly. Any help will do or advice thank you Is my name is bill

@rtclinic 2 жыл бұрын

Bill, You definitely need home oxygen and likely a bipap when you rest (depending upon your co2 levels). I would try to get into your primary care physician and try to get an order for an overnight oximetry study.

@rajnbull 2 жыл бұрын

@@rtclinic believe it or not it's not the doctor but the insurance company that's pushing back insurance company says my CO2 levels are perfectly fine. I wish somebody would explain that to the doctors that saved my life on April 7th and being admitted to the hospital the next 11 days being on a BiPAP machine. also on have a medical bill that's over $175,000 for 11 days. I guess I made that up to according to the insurance company. I was always told insurance companies your great when you're in that glass wall, but when it comes time for you to break that wall to get help from that insurance company Nobody's around. that's okay my life expectancy now that I know what it is it's roughly six months according to my pulmonologist. if I get another severe attack at home I know what I'm going to do and it's going to be less than $0.55 to do it. thank you for your commentary.

@ABHISHEKSHARMA-ci1oy 3 жыл бұрын

Sir plz plz guide me , if we set Respiratory rate 10 and patient spontaneous breathing rate is 15 so we will get RR 25 or 15 in monitoring parameters

@rtclinic 3 жыл бұрын

The total rate will be 15. The set rate is just a backup. 10 breaths will make sure a breath is taken every 6 seconds

@ABHISHEKSHARMA-ci1oy 3 жыл бұрын

@@rtclinic Thanks a lot sir

@LEARNING-MEDICAL-EDUCATION Жыл бұрын

can we use AVAPS in NIV mode?

@rtclinic Жыл бұрын

Yes

@nq1019 Жыл бұрын

hello, cn this be used on someone with a tracheostomy and a deflated cuff?

@rtclinic Жыл бұрын

Nope. It would need a sealed airway to measure the correct amount of tidal volume.

@nq1019 Жыл бұрын

@@rtclinic Thanks for replying. I asked because my brother who is in ICU with anoxic brain injury and recurring pneumonias was put on this machine with cuff down, which led to aspiration pneumonia. I was told by the treating pulmonologist that in this machine he could only have the cuff down/deflated because the trigger alarms are not the same as in the ventilator. the next week another Pulmonologist came and said to put "cuff up" because of aspiration risk. Unfortunately the RT's that I asked the question were not helpful 😕

@rtclinic Жыл бұрын

Are they attaching the circuit to the trach or are they using a mask with a capped trach?

@nq1019 Жыл бұрын

@@rtclinic they attached to the trach.

@rtclinic Жыл бұрын

@N Q Good. There are a couple of technical pieces to the equation. Most noninvasive circuits are vented, in this case the cuff will need to be inflated. If it is a non-vented circuit the cuff will be deflated. The RT should know the difference. This would explain why the pulmo MD might give different answers because they didn't know what type of circuit is being used.

@veerchasm1 Жыл бұрын

I’m not sure why but RTs I work with can understand Volume Ventilation with an intubated patient but cannot understanding AVAPS… 😂

@rtclinic Жыл бұрын

I usually find that once the physicians figure it out, they'll order it on everyone😁

@veerchasm1 Жыл бұрын

@@rtclinic I put a kid on AVAPS in ER, it was like looking at dogs listening to a dog whistle

@daddyguy29 5 ай бұрын

They're just a lil slow it's like acvc with pressure regulation. (PRVC). The residents didn't understand. I saw them put 30 orders in trying to put the order in correctly.