The Great APRV Debate

Season #1 Episode #35

In this podcast episode titled "The Great APRV Debate," the hosts, Rory Spiegel and Max Hockstein, engage in a passionate debate about the use of Airway Pressure Release Ventilation (APRV) in critical care. They discuss the controversy surrounding when and how APRV should be employed, examining various aspects of the mode and its potential benefits and drawbacks.

Five key takeaways from the debate are as follows:

  1. Controversy Surrounding APRV: The podcast highlights the ongoing debate within the medical community regarding the appropriate use of APRV. Some argue for its selective use in specific cases, while others advocate for its broader application in mechanically ventilated patients.
  2. Lack of Clear Evidence: Both sides acknowledge the limited and somewhat inconclusive evidence regarding the efficacy of APRV. They discuss the challenges in conducting rigorous studies on APRV and note that there is no large-scale randomized control trial supporting its widespread use.
  3. Hypercapnia and Respiratory Acidosis: The hosts delve into the importance of managing hypercapnia in ARDS patients and the potential consequences of allowing significant respiratory acidosis. They discuss the need for careful control of minute ventilation when using APRV.
  4. Hemodynamic Considerations: The debate includes a discussion on the impact of APRV on hemodynamics, with a focus on right ventricular strain and pulmonary vascular resistance. The hosts explore how APRV can affect these parameters and whether it is a safe mode for patients.
  5. Training and Familiarity: The hosts emphasize the need for healthcare professionals to become familiar with APRV through education and practice. They acknowledge that it may require a learning curve but stress the importance of building expertise in using the mode safely and effectively.

Overall, this debate provided valuable insights into the ongoing discussions and considerations surrounding the use of APRV in critical care, highlighting the need for further research and the development of best practices in its application.