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APRV Protocols

Airway Pressure Release Ventilation (APRV) protocol uses a controlled pressure method to assist patients with taking a set number of breaths. The APRV protocol was developed from basic concepts of CPAP machines (continuous positive airway pressure). Patients can take breaths under their own power but are also supported when necessary to meet the required number of breaths.

  1. High PEEP settings

    • Set the PEEP high settings of the ventilator being used for the APRV protocol. PEEP stands for positive end expiratory pressure. According to the Queens Medical Center, this setting will control the amount of oxygen that is provided to the patient in addition to the positive pressure support that keeps the airways open. Improperly setting PEEP high can affect the oxygenation of the patient. The patient's comfort should be kept in mind when determining the PEEP settings. Once the patient is connected to the machine, he should be monitored for over distension, which will occur if the PEEP high setting is set too high, according to Vanderbilt University Hospital.

    Low Peep Settings

    • The low PEEP setting is used as a baseline for the machine. According to the Vanderbilt University Hospital, the low PEEP settings are usually set at zero for patients without severe respiratory complications who simply need airway support. Patients with respiratory complications may not be able to exhale completely. If a patient is unable to exhale completely within the average time frame between breaths, the low PEEP setting will need to be modified to allow the patient time to exhale completely and avoid over distension, according to the protocol at the Queens Medical Center. Low PEEP setting is used to help ensure the patient is able to exhale completely and prepare for the next breath.

    Monitoring

    • Monitoring the respiratory efforts of the patient to determine if the settings of the machine are correct is a key part of APRV protocol, according to the Vanderbilt University Hospital. An oxygen saturation monitor should be connected to the patient to monitor the oxygen levels in the patient's blood. The percentage of oxygen that is provided to the patient through the machine can be adjusted to improve the patient's oxygen saturation levels. The patient should be able to rest comfortably while connected to the machine, according to the Vanderbilt University Hospital APRV protocol.

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