Advanced Vent Modes - PRVC, APRV, HFOV and MORE!

[@ICUAdvantage]

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[@veerchasm1]

I’ve been an RT for 29 years, great explanations

[@ICUAdvantage]

Awesome to hear this! Thank you and glad you liked it! :)

[@TudyaliweChakwiya]

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[@RespiratoryCoach]

Sharing this resource with all of my students! Great, simple break down of these "advanced" modes of mechanical ventilation. Strong work, Eddie! Appreciate the shout out.

[@ICUAdvantage]

Awesome! Glad you liked how it came out and hope your students find it useful!

[@khadijabelqas]

Thank you!

[@ericbalti]

​@@ICUAdvantage lol my kn😊

[@kyleessex6301]

I love our videos, I do. I do need to mention for many who may be watching this that it is an important distinction regarding compliance as the the ability to expand and that the force acting to contract is elastance. This is a concept that I have even seen many Physiology PhD's mix up. So compliance force to expand, and it acts in opposition (Inverse relationship) to elastance or recoil. This plays a factor in ventilation, perhaps most easily explained with COPD patients. Barrel chesting is associated with an increased compliance with the associated decrease in elastance.

[@hannahthompson93]

Thank you for these! I'm a couple weeks into orientation in the CVICU. I have been totally unable to grasp the concepts behind the various modes of mechanical ventilation despite other nurses' attempts to explain it to me. These videos have literally saved me. It's so understandable if explained well. Now I'm going to go watch your drip videos...

[@ICUAdvantage]

So awesome to hear this Hannah! So glad that this video was what you needed! Congrats on the new position. Lots of good videos here I think you'll like. Welcome to the channel and best wishes on your new nursing adventure! 😊

[@JoquanBoyce]

JUST WANT TO SAY THANK YOU FOR THESE VIDEOS AND THE GOOD INFORMATION YOU HAVE PROVIDED I AM THINKING OF GETTING INTO RESPITORY THERAPY AND THESE VIDEOS ARE GREAT INFORMATION TO BE ABLE TO WATCH AND GET EDUCATED. I HAVE WATCHED LIKE 7/8 VIDEOS JUST FOR THE GREAT INFORMATION THAT YOU PROVIDE

[@conniera]

I'm an RT student and that was an excellent to the point explanation of those modes. Subscribed. Thank you!

[@ICUAdvantage]

Awesome Connie! Glad to have you on board and glad you liked the video!

[@wa590]

Thank you!!! You helped break it down in simple terms, something I haven’t been able to get from anyone yet (including my professors). Thank you!!!

[@ICUAdvantage]

Wow, really awesome to read this! Thanks for the comment!

[@maddiegirlx4]

Thank you so much! I am brand new nurse starting on an ICU floor!

[@ICUAdvantage]

So exciting! Congrats on the new position and really glad that you enjoyed the video!

[@D1G1TALSYNAPS3]

This is good supplemental education but please talk with your RTs to get more info.

[@moritzwolle2141]

Hello, learned a lot while working on covid icu. It really helped to daily see different stages for ARDS for months... :)

[@Lishaaaaaaa]

Oh, you absolute star. This is excellent revision material, especially for someone like me who's a bit poorly atm, so information retention is a struggle.

[@christinemjs]

I have just started in ICU and I am finding all of your videos very very helpful!! Thank you!

[@ICUAdvantage]

This is so awesome Christine! Welcome to the amazing world of critical care! Its such a fun journey of life-long learning and truly caring for people at deaths door and actually playing a part in saving peoples lives. Its such a fulfilling career and I wish you the best. So glad to hear that you find these videos useful!

[@MrKir03]

You sir are God sent. Extremely helpful for my ICU rotation

[@ICUAdvantage]

Truly happy to be able to help!

[@RossAngeloNegrillo]

Great videos! Would like to ask if you have videos for troubleshooting patient ventilator dyssynchronies? Thank you so much!

[@ICUAdvantage]

I don't but great suggestion. I'll add to the todo list

[@arshadhussain8797]

Kindly make more videos on ventilators like more advanced modes, ventilator graphics and protocols followed in ICU...these videos are really helpful ! Thanks👍

[@ICUAdvantage]

Really glad to hear you liked it Arshad!

[@laurenguhr2856]

We use BiLevel alot - sounds similar to APRV

[@Medicinalmagic911]

17year medic. This is incredible. Thank you

[@ICUAdvantage]

Awesome! Glad you liked it!

[@gingingsisangag]

Hi! Thank you for this Eddie. Could you pls add a video regarding mech vent alarms

[@arseniohardrick3123]

Thank you Eddie, please keep pumping out the content.

[@ICUAdvantage]

Will do! Glad you liked it!

[@Reyalegro]

Thanks, these videos are really helping me study for my FCCS course!

[@ICUAdvantage]

Awesome! Glad you are finding them helpful!

[@nan_c77]

Thank you for the Ventilators videos! What a great way to review!

[@ICUAdvantage]

Awesome to hear this! You are very welcome!

[@akashmaheshwari2016]

Nice work...the way you have explained the entire ventilator series is amazing 🙌🙌 I have only one Doubt!!.. The PRVC should be volume control as we set the target volume which is needed to be achieved by the the ventilator by adjusting the pressure? You have mentioned it as pressure control@ 10:08

[@karawelch1123]

Thank you for your AWESOME videos!!! I am and RN starting in ICU this month and am very excited; your videos are easing my nerves. I have a suggestion for a video to make: transvenous pacing. Thank you :)

[@ICUAdvantage]

How exciting Kara!! Its one heck of a journey but working in the ICU is truly unlike anything else. I wouldn't trade it for the world. I'm so glad you like the videos and I really appreciate you taking the time to leave such a great comment! 🙂 Also thank you for the suggestion. I actually have temp pacing stuff coming up on the to-do list relatively soon, so keep an eye out for those videos when they come out!

[@dawnbundy4308]

Thank you for the break down and ever so patient explanation!

[@ICUAdvantage]

Really happy to hear this! You're welcome!

[@nicklind39]

Incredibly helpful. Thank you so much. All your content is great.

[@greensahuaro2834]

your teaching is awesome!!!!! you go to the point!

[@ICUAdvantage]

Thank you so much. I try, but sometimes feel like I drone on, and other times like I don't cover enough haha

[@greensahuaro2834]

I think you'll make a GREAT UNIVERSITY PROFESSOR.

[@mohamedhabibberhanu6553]

Thank you sooooo much , your channel is so powerful and very educational. I really enjoyed when I listened to it

[@ICUAdvantage]

Wow, thank you so much! Really happy to hear this.

[@alexwoelfel8934]

Can you explain the Weening process for pressure control and why pressure control is the mode used for this? I am confused why we wouldnt just use something like PRVC? Pressure control seems like it gives less control to the patient as their is still inspiratory pressure and a frequency and time, where PRVC just adjusts it to what is needed or if the patient is getting better.

[@ICUAdvantage]

I think you may be confusing pressure control and pressure support. Typically pressure support is whats used for weaning trial. No delivered breaths with just PS and PEEP to assist the patient, although for weaning generally at low levels. If they do well, its a good indicator they would do well breathing on their own without the tube.

[@carleighmiller542]

I FINALLY UNDERSTAND. Thank you so much. You made learning this actually entertaining!

[@ICUAdvantage]

YES!!! So awesome to hear this!

[@raman6972]

Thank you...really helpful. Can you explain how we choose the mode of vent for our patients i.e vol or press control or pvrc. i.e patient with chest inury, type 2 resp failure (COPD), severe asthma, CAP etc etc I was taught traditionally to avoid vol control in airway obstructive diseases...is that still true?

[@ICUAdvantage]

Great question. So, much of it depends on 1) patient tolerance and 2) goals of care. Remember between volume and pressure we are in control of just one of the variables. The other happens as a result, instead of just setting it. In obstructive disease there may be benefit in regulating pressure to achieve volumes, but its almost never and always and/or answer. Honestly a quite complex answer to deciding when to use what, and certainly some providers have preferences to use one over the other more often.

[@TARUNJAKKULA-y7r]

Can you pls do a video on interprwting VENTILATOR GRAPHICS

[@TamNguyen-lu9fd]

Many thanks, you’re so great.

[@elevatenursing]

This is pretty useful! I will be referring to these notes in future and to my students too. Thanks!

[@ICUAdvantage]

Awesome! Glad you liked it and thanks for spreading the word!

[@authman-alshibly]

How far is the 'test volume' that the ventilator uses in PRVC from the 'targeted volume' usually? What does the ventilator do if the lungs' compliance does not match the 'targeted volume'?

[@BIGBADRAEVEN]

SUBSCRIBING ! I just got out of school ,and I could never understand pressure control; now I do‼️

[@ICUAdvantage]

So awesome! This is great to hear. Thank you!

[@lonestarbulls9001]

amazing video! will you be posting more in-depth videos on the individual advanced vent mode settings? Thank you for making these!

[@ICUAdvantage]

Glad you liked it. And yeah probably in the future, but not sure when

[@danronck3636]

Thank you for this amazing Video, I'm a 3rd year Med student and i would have a Video suggestion: what skills would you and other RN value in young students coming to ICU for their internship? I love working with RN and would love to be able to give you guys as much support as possible. Thank you

[@ICUAdvantage]

You're very welcome. Honestly, as an intern being around experienced critical care nurses, the best skill you can bring is being willing to listen to the bedside RN. Especially the experienced ones, as you will be surprised how much you can learn. The best attendings learn to lean heavily on the thoughts and suggestions of the bedside RN as they are there for so much more time and see many little things that can easily be overlooked.

[@danronck3636]

@@ICUAdvantage I've already come to that point, I did some voluntary internships and I noticed right from the start how precious our RN are. I love them and treat them like gold, bring chocolates or breakfast to the shifts. I just love my ICU RN. But fair point, I do agree that too many MedStudents underestimate the RN. But honestly, no MedStudent could ever reach the depth of knowledge of the RN. Thank you to all you amazing RN out there🙏🙏🙏

[@samuelhumphrey2823]

Thank you im a new ICU nurse

[@ICUAdvantage]

Awesome! Welcome to the world of critical care Samuel!

[@ruthtarasko3849]

Eddie! New subscriber here and loving your content! I’m wondering if you don’t already have one on how to understand CXR. We take them daily in our ICU and I’m embarrassed to admit I have no idea what I’m looking for when I look at them with the team.

[@ICUAdvantage]

Yay welcome aboard Ruth! Happy to have you here! Don't be embarrassed. If no one every showed you anything, its hard to know what to look for and they don't really cover this at all in school, but is very important, especially working in the ICU. I don't have a lesson on this one yet, but it def is on the todo list to get to!

[@21klauss]

Thank you 😊 I totally understand PRVC now

[@ICUAdvantage]

You're welcome 😊 Glad this video helped!

[@djibrilyadd4131]

Very relevant

[@ohappye745]

Thank you, your video is really useful for me.

[@ICUAdvantage]

Glad it was helpful!

[@moila04]

Thanks again for the video ☺️.I have a question about the difference between VC and PRVC. With VC, the set tidal volume is always delivered. What happens if the lung compliance is really bad, can the vent still always deliver the set tidal volume? And in PRVC, there is a ‘target tidal volume’. So is the main difference between VC and PRVC, is that in VC, the tidal volume is always the same no matter what the lung compliance is but in PRVC the tidal volume changes breath by breath?. Is it possible I’m that the target tidal volume is never achieved in PRVC?

[@shawnjade7005]

To answer your first question about VC, yes it will deliver the set volume despite having a bad compliance. The pressure will be high and may cause volutrauma.

[@greensahuaro2834]

Many thanks!

[@ICUAdvantage]

You are very welcome Carlos!

[@gideonecube7552]

Many thanks for the lectures. I appreciate your work 😊

[@ICUAdvantage]

You’re very welcome Gideon and thanks so much for taking the time to leave a comment!

[@Apratim98]

Thank you so much for this great video!

[@ICUAdvantage]

You're very welcome!

[@safaasaud]

Please do videos about ICU bundles, also most common procedures.

[@ICUAdvantage]

Thanks Safaa! Any particular procedures you have in mind?

[@safaasaud]

ICU Advantage ECMO, Central Line, Arterial Line, Chest tube, Intubation/Extubation.

[@ICUAdvantage]

@@safaasaud Just about all of those are on the to-do list, except a-lines and extubation. Adding those now!

[@spicefaith7419]

Thank you so much

[@ICUAdvantage]

You're most welcome

[@TS-pq1iy]

Thanks for these videos! So helpful.

[@ICUAdvantage]

Awesome! So glad you like them!

[@ahmedelkomy6309]

awsome. please, could you tell me about the software you are using in explanation?

[@ICUAdvantage]

Adobe Photoshop. Then use Astropad Studio to put my Mac screen on my iPad to write with the pencil.

[@alissoncarmiol]

Amazig explanation thank you so much.

[@ICUAdvantage]

You're very welcome Alisson!

[@iia61]

Thank You!!!

[@ICUAdvantage]

You're welcome Iva! 😊

[@mhossain333]

Nicely explained

[@ICUAdvantage]

Thank you Mahtab!

[@mundymorningreport3137]

Hey, I really appreciate the video explaining the mechanics and clarifying the limitations of this essential function of life and healing. So, why not bypass the limitations entirely with HBO2? Seriously, can any ICU be complete without it? Anything that you can bring forward on this therapy would be appreciated. Thanks so much. Why isn't it more popular? B

[@ICUAdvantage]

HB02? Do you mean HFO2?

[@robertbrindus6597]

Your videos are a great help in general, and that's why I say thank you. But in this particular case, I can't understand from your explanation the differences between classic VC and PRVC. You say that in PRVC we set a 'target volume' and the ventilator it's constantly adjusing the Pinsp based on the compliance, to achieve that 'target' set. But the same it's in standard VCV, as the constant 'Tidal Volume' that we set is achieved by automatically regulating Pinsp. Sorry, but from your video I could not understand why PRVC is an "advanced mode", as there seems to be no difference to standard Volume Controlled Ventilation

[@ICUAdvantage]

Sorry that it wasn't clear. PRVC and VC are quite similar, but VC you have a SET Vt and each breath will be approximately at that set volume, assuming no pressure limits are hit. PRVC adjust the pressure used to deliver the breath slowly over several breaths. You set a GOAL Vt but as compliance changes volumes will change with breaths until the ideal pressure is achieved. PRVC gives a lot of the protective benefit of pressure control, while still working to achieve a goal tidal volume. Its a smart mode, much smarter than VC or PC, and hence why it ended up in the advanced modes lesson. A lot of places don't have this mode available or hardly ever use it. Hope that makes sense.

[@robertbrindus6597]

@@ICUAdvantage It makes more sense now, indeed. I'm an ICU resident doctor in Romania using a General Electric anaesthesia machine (started with my anesthesiology rotation) and I could not find this mode on my software. The most advanced are SIMV + BV (backup volume) and PSV-Pro (pressure support).

[@renandclervoyant5524]

Bilevel is the same as aprv

[@freecopt4003]

why do not you call it vol control ? because the set is targeted vol not pressure and pressure is variable

[@ICUAdvantage]

? What are you referring to?

[@freecopt4003]

@@ICUAdvantage Dual mode pressure regulated vol control ventilation

[@ICUAdvantage]

Oh got ya. Well essentially you aren't setting a set volume, but a volume target. Therefore the volume given may not always be what you are looking for, based on the pressure regulation. I think we could probably say its a primarily volume focused mode, but not truly a volume control. But really, its just semantics at this point too :)

[@llanceend2970]

Hey buddy many thanks for super content as always ..only that sometimes if you can please don't rush the topic particularly as these are complex topics ..here I feel you overtly rushed ..otherwise you just dumping critical knowledge and not allowing people to take the tips in. Cheers

[@ICUAdvantage]

Hey thank you so much for the feedback. Its tough because I have some people who say I drag on too much and others who say I go to quick. I try to find a good balance with it but it certainly is a work in progress. If there ever is a part that you need further clarification on, let me know and I can try to explain more, or perhaps it might make for a good individual lesson later on. Appreciate you and your support!