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gflear
#1 Posted : Tuesday, May 15, 2012 7:01:04 AM(UTC)
In new work being done by Dr. Habashi and professor Gary Nieman in Professor Nieman's animal lab they have found that maintaining a 75% trap with the T Low allows for pretty incredible alveolar stability.
sjsnyder
#2 Posted : Friday, May 18, 2012 9:18:38 AM(UTC)
Is it the same even in very small patients? That means that a neonate will likely have a very, very short T low, correct? What is Dr. Habashi using in his animal models for T low?
gflear
#3 Posted : Friday, May 18, 2012 11:14:44 AM(UTC)
While I am not involved in the animal reaearch being done, through conversation I blieve they are using 75% as the trap in all patient ranges. For animal testing of the little tykes I believe they are using a rat model, so plenty small. and I believe the times can be quite small even like 0.15 for T Low

Edited by user Friday, May 18, 2012 11:17:08 AM(UTC)  | Reason: Not specified

bobbie.brewster
#4 Posted : Tuesday, May 29, 2012 7:22:09 AM(UTC)
Geoff,

Speaking with Penny, she too mentioned this was coming. So question is,with an T-Hi of 8, you would have a T-Lo of 0.06????? Just want to make sure I get this right.. and when should I impliment this on our patients? Is the standard 75% for all patients or is there an exception to this rule? Finally, when do you DC this, or do you leave it on until switching to CPAP?

You know this goes against everything I've been taught, this will take some getting used to. Thanks for the help.

Bobbie, BSRC,RRT
gflear
#5 Posted : Tuesday, May 29, 2012 9:44:13 AM(UTC)
T High and T Low are not really interconnected numerically. The T High is available time for recruitment and alveolar-capillary diffusion. Spontaneous breathing at T High also helps to move CO2 and helps to keep T High longer. Now for T Low, 75% trap is based on normal to resrtictive lung pathology, the main criteria for using the 75% trap is adequate expiratory flow to get decent volumes with this 75% trap. When you would NOT want to use a 75% trap is a patient with chronic obstructive disease which will present itself witha very flat expiratory flow wave form (say for example the flow only dropping from a peak of 30 LPM to 25 LPM in 1 second, mathmatically the trap is still at ~83%, but with severe chronic obstructive disease the trap may need to be extended to 50% or possibly even 25%. HOWEVER, I would leave using APRV on chronic obstructive patients to medical teams VERY familiar with APRV and using it with COPD.
In terms of implementing APRV - the sooner the better, APRV uses the open lung approach to mechanical ventilation and as such is considered a "Lung protective" strategy. In the animal lab Dr. Habashi was using APRV as a lung protective strategy with a septic injury model and APRV with its "lung protection" did a great job of preventing ARDS in their septic model. The other really good thing about starting early is less pressure. Remember if the lung has not been injured it is gong to take a lot less pressure to keep the lung open.
In terms of weaning, we do suggest maintaing the 75% trap as you drop and stretch the high pressures and times and then exactly as you suggested, when you can set CPAP at the MAW level you should be ready to go out of APRV.

Hope this makes sense!

Edited by user Tuesday, June 05, 2012 12:52:07 PM(UTC)  | Reason: spelling

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