PRVC (Pressure Regulated Volume Control) PER REQUEST!!!
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- Опубліковано 18 кві 2019
- Please excuse my error at around the 11 minute mark. If delivered tidal volume is greater than (not less than) target Vt then flow is decreased to decrease pressure on the next breath to deliver a smaller Vt.
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Damn! Your depth of understanding and expertise on these topics is amazing! Thanks for helping us out by making such great videos..
Great video, very well explained. I am not an RT but got the whole concept of
PRVC ventilation mode.
THANK YOU!!! YOU MAKE MY LIFE BETTER WITH THESE VIDEOS, IM GET CONFUSED ABOUT MODES AND WHEN I LISTEN TO YOUR VIDEOS AND SEE YOUR NOTES I CAN FULLY UNDERSTAND WHAT THE BOOK SAYS.
Awesome! That's what I like to hear. Glad you find the channel helpful. THANK YOU for watching and commenting, Paola!
Thank you for taking the time to make this video and educate your listeners! I appreciate it :)
My pleasure! Thank you for watching and commenting!!
I just watched your video on APRV, and then jumped on to your PRVC presentation! Brilliant video for newbies like me! Thanks !
Cool. You want be a newbie for long. Thanks for watching and commenting.
Your videos are so helpful , I love how you’re so knowledgeable
I am a new icu NP and have been studying your videos. You are very talented and you have literally changed my life in regards to understanding ventilator mechanics
Awesome, Selina! Thanks for watching and kindly commenting!
Sir you’re definitely the best. I got my first job as an RT two months ago and can tell it’s not easy at all to deal with everything I’ve learned during my educational journey. But ur videos are great, it made more confident and knowledgeable enough to start handle vented patients who are mostly COVID-19 ones. These kina patients are in advance modes that I’m not used to, but you made it super easy to understand. You’re work is appreciated and the thanks word is not enough for you :))) Best wishes!
CONGRATULATIONS!!! Welcome to the field of RT. You are absolutely correct. You spend two - fours years learning all this stuff and then you graduate followed by a big exhalation of accomplishment, but that's only the beginning. Once working, the clinical application of all the knowledge you gained is required, and it's not a multiple choice exam, it's life. Staying engaged in the learning process post graduation is the key to developing into an extraordinary RRT. Your career depends on it, and your patients deserve it! The journey continues...
Thank you for watching and kindly commenting. Best wishes!!!
Thank you for ur help and support. U always give the best lectures. Now i understand a lot more on this mode.
Thank you for watching and for your kind comments. Good luck!
I work in a facility that uses this mode a lot. Most patients tolerate this mode. PB980 comes as VC+ Thank you for this video!
..a truly great man perfect coach and generous sharer ..my unlimited gratitude 🙏
ياشيخ روح جعلك تسلم وتدخل معانا الجنة I love u man !!! 🤍🤍🤍🤍🤍
Not sure what this says, but I love u!!!
Hi there... you are so great in explaining everything.. thankful that I have found your videos. 😊😊😊😊
Thank you for sharing your kind words and watching. I appreciate you!
Thank you for sharing your knowledge; currently in icu with pt on PRVC
I am about to start my NICU rotation at a Level 1 NICU next week. I need help with HFOV, why/when you use it in adults/older pediatric pts, and how it works and why. Thank you! You explain things so well!
You have helped me SO much, thank you.
Awe, thank you for watching and for the kind comment. Glad to help! Best wishes.
You are absolutely genius, thank you !!!
thank you coach, I'm learning a lot from your videos. philippines RT here😊
Hello Jeff and the Philippines!!!! Your very welcome. Glad you find them helpful. Thanks for watching and commenting!!!!
Thank you for your explanation!
Thank you for watching! Hope it helped!
Thank you so much! I understand better now 😁
Fantastic Explanation
Very good review & breakdown!
Glad you liked it!
you are the best thank you!
Thank you so much for all your efforts...Much Appreciated..
Thank you, Kevin! Much appreciate you watching and commenting.
@@RespiratoryCoach I have reccomend your vedios even to my respiratory therapy graduating friends...its definitely gonna be helpful in our college exit exams and the future tmc and cse exams..
@@kevinvarghese2 Thank you, Kevin, for the recommendations. I appreciate you watching and commenting. Hope to hear more from you soon.
Well explained sir! Thank you
Thanks and thank you for watching!
Really good explanation I get it now!!!
Thank you for the lecture sir , sir in prvc we set a pressure high limit , also in the ventilator theres a setting for alarm limit in there we can set a limit for pressure too but whats the different between these two , settings , ( alarm limit seeting and prvc pressure high limit setting ) will both stop breath when pressure goes high
Thank you bro it was so understandable
Heyy Sir, u have a talent for teaching..idk if u already teach but u would be helpful to new peeps coming into the career:)
Thanks, Blanca! I appreciate your kind words. I do teach as a profession and do my best to help all students, either directly or indirectly. Thanks for watching and commenting.
Amazing Professor!!!
Thank you kindly!
Very helpfull! easy explained!
Thank you! All your lecturers are very useful! You are a great teacher! Could you explain about which patients are beneficial from PRVC mode . The hospital l work use it for every patient. I just wonder
Hello! You're very welcome and thank you for watching. I don't think there is one patient population that PRVC benefits the most. I also don't have a problem with every patient being placed in PRVC. When it becomes a problem is when we fail to recognize the patients that PRVC IS NOT benefiting. Do we get them out of PRVC in those cases, or do we just let the p-v asynchrony continue to happen or give more sedation? I like the way you think. Don't get put in a box when it comes to a specific mode of MV. Hope this helps!!!
Hi, I am a nurse and really appreciate your vidoes. I have question that is there any down side of PRVC mode? Because if not, why don't doctors use this mode for every case(like except when using PC mode)? Then we don't hv to worry about barotrauma.
Great video. I’ve been an RRT for 30 ish years. My question. At 9:38, also 11:03 (roughly) didn’t you get the vent response to the target tidal volume backwards from what it really does? Meaning if the volume comes back too high, then the flow should decrease and thus decrease pressure and decrease tidal volume? If I’m wrong, please let me know. And if I was correct, no offense intended. I’m happy I found you here and even if you are a seasoned veteran like me, it’s always good to review and hone your skills.
Hello fellow RT veteran! You are 100% correct!!! I did misspeak at the mentioned times. Thank you for bringing that to my attention. I will make that correction in an updated video. No offense taken! I appreciate you watching and contributing. Thank you!
I use the Trilogy 200. If patient is in SIMV/ PC mode is this SIMV PRVC as you spoke of ?
How high can one set a pressure alarm? I have transported COVID pneumonia patients on CMV+ with pips in the low 30s and an alarm set at 40. From what I have always understood is that pip=Pplat in a PRVC mode and yet I have heard alarms being set at 40+. Should I be aiming for pips
Can i ask, If my Rr is set to 30 how much E time should i set? Thanks for your video.
Since these are pressure controlled breaths, is plateau pressure going to be equal to whatever the patients PIP is?
the high limit pressure alarm setting that cuts off the volume and breath within 5 cmH2O of set peak pressure alarm- does this only apply to PRVC or which other modes have this function ?
you are a hero!
Just a regular guy that happens to know RT and is willing to share with the others! Thank you for watching!
How do you determine the peak expiratory flow from a ventilator waveform
How do you calculate it if you are not given
Awesome!
Is there anyway that you can compare PRVC with VAPS and PSV, and VSV? they're running together for me.
Excellent explanation ty
Thank you for watching and commenting!!!! Best wishes!
Hi Joe would you do a video on why you wouldn’t put a suspected PE patient on Bipap.
Joe, can you go in-depth on PRVC? Why use it ? for who? what does it accomplish?
It's on the list, Max. Thanks for asking!
What kind of patients would be ideal for this mode?
How would a patient benefit from prvc vs acvc if pip and plats are not any issue?
Also, there’s a common consensus at my facility to switch patients to prvc if they breath stack. I think they assume the little rt inside the vent on this mode will fix it.
Are we setting Minute volume or tidal volume in PRVC?
You need to understand the concept of constant flow pattern and decelerating flow pattern.
Volume control is a constant flow pattern, while pressure control is a decelerating flow pattern.
In PRVC you are ventilating with decelerating flow pattern while assuring a set tidal volume.
I Hope you do Videos for Mechanical Ventilated Covid Patient 😊
I’m confused about something I heard today: “walking away”. I was told that the vent can “walk away” meaning the pressures are lowering and essentially walking away from its support to the patient and it seemed negative … but if the vent is adjusting to every breath wouldn’t this not be an issue? 😩🙃send help
Hi coach, I'm a first year student and I'm trying to get ahead of vents while I can. Is there a particular reason why you wouldn't ever just start out every patient on PRVC? It seems to me like the most complete mode especially if you're not 100% sure what's wrong with the patient.
Hi Mister M. Not at all. I think most of the time vent mode depends on provider and regional preference, rather than patient presentation. Personally, I like to start in a VC mode to allow me to assess raw and compliance. Your TMC almost always starts out in VC, but smart thinking and great question!! Thanks for watching!!!
Can you explain SIMV pc+ps it's confusing to me
Joe, could you please elaborate a litle more on the difference between A/C VCV and A/C PRVC. So the fundamental difference is the PIP high limit only? And basically if I set the alarms on vent in VCV and PIP high limit in PRVC to the same level - the result is the same in case of inabilty to deliver desired Vt - look for underlying cause ) ?
In this case I don't get what are the indications for PRVC?
Got it. Will address soon! Thank you very much for watching and commenting.
I am anesthesiologist in india and found your lecturer very useful and interesting ,recently i found you have GE V500 ,will you very kindly tell the cost of this ventilator.regards.
Hey there! I’m a nurse and your videos have been very helpful to me! One question, I’m confused as to why you are setting the peak inspiratory pressure alarm vs the plateau pressure alarm. If you’re setting this alarm to go off when there’s an increased pressure due to a less compliant lung, wouldn’t this reflect plateau pressures and peak would represent the airways? Thanks!
Hi Bailey! First, I love it when nurses show up and ask questions on this channel. So thank you for watching and for commenting. I've got your question noted and will get your video response out soon. Stay tuned!
Respiratory Coach thank you so much! I will keep an eye out for it!!
@@baileycoggins7986 Here ya go! ua-cam.com/video/GncaB2DzKf4/v-deo.html
Thanks....that was really helpful...
Can you make a video about the physics of how a pressure support is generated??
Hello! Generated in the sense of triggered? Or the actual physics of the pressure change? Let me know so I can best answer your question. Thanks for watching and commenting, Tarundeb!
@@RespiratoryCoach actual physics of the pressure change... How a sudden peak pressure level is generated...
The I time throws me off. In VC and PC the time is the trigger so why I time becomes the cycle time in PRVC?
I got you on the list. Stay tuned. Will answer soon. Great question by the way.
Great explanation , but I have a concept according to the mechanism of work of PRCV mode , it not a weaning mode right? correct me if I'm wrong. Thank you.
Hi Munirah! The concept of weaning modes is constantly evolving, and to the point to where now evidence supports full mechanical ventilation with daily spontaneous breathing trials. So yes, PRVC should not be consider a weaning mode, but rather a pressure control mode with the thought of preventing volutrauma. Hope this helps!
I wonder is PRVC trade marked to a brand of vent? In our area in Florida, MMV seems to be used a lot.
I believe it is. What vent do you primarily work with in your area?
@@RespiratoryCoach Draeger Infinity v500
Thank you
Thank you for the multiple comments. You're very, very welcome.
Thank you for your brief explanation ! but what is advantage of this mode from others mode?
The ability to control pressure while also maintaining a desired minute volume for adequate co2 removal.
@@RespiratoryCoach Thank you for your valuable answer to my question,I get better understand on this mode.
At what PIP would you set for a well-known COPD patient?
Hello, use mean airway pressure from volume control to approximate where to begin pip in pressure control. Remember your COPDers have an increased compliance, so don't be shocked if they don't require much insp pressure to generate an acceptable tidal volume. Make sense?
Is PRVC the same as VC+. I have never worked on a vent that has VC+.
Yes. Thanks for watching and commenting with your question.
Thanks alot
You are VERY welcome!!! Thank you alot for watching!!!
great vid. question. if i have a pt on VC-AC/PRVC and they are taking large spontaneous breaths in between set rate. breaths that end up being larger than set VT. my question is, if the flow and volume are continuously being decreased because the pts spontaneous VT is greater than set VT, isnt it safe to say that the patient is getting a very "low" level of support for each of those spontenous breaths? my current issue with the hospital I am at now is that if a patient fails there 5/5 SBT trial, the patient goes back to VC-AC/PRVC instead of just going up on pressure support in PSV. my arguement is that the support from the vent in VC-AC/PRVC is unmeasurable when they are inhaling larger then set VT because the pressue and flow are being decreased for every breath. i guess my question is, what type of support is measurable for a pt that is doing this? and no, they do not want us to use SIMV!
Hello! Great scenario based question. The first thing I would like to point out is that I'm not sure how the patient is able to generate a spontaneous breath in any AC mode. Of course, we know that they can trigger a breath in AC, but beyond that point the breath delivery is based on what is set.
What I wonder might be happening is something that we commonly see in VC-AC. We set a tidal volume that doesn't meet the patient's neural drive to breathe. In other words, the vent gives the set tidal volume, but the patient isn't satisfied with that volume, so they immediately trigger another breath. This is what we call breath stacking. When we observe the exhaled tidal volumes, we'll see a very small exhaled Vt, followed by a very large exhaled Vt. For example, tidal volume is set at 400mL. Patient breath stacks. We might see an exhaled Vt of 25 mL followed by an exhaled Vt of 775 mL. All of that to illustrate what I think might be happening with your patients in PRVC. The fact that you're in AC-PRVC eliminates the option that those large tidal volumes, in between set breaths, are spontaneous breaths.
Another possibility is that the patient's diaphragm is dropping faster than the breath is being delivered, which in PRVC will confuse the vent. The diaphragm dropping during a breath increases compliance, as opposed to a resting diaphragm during mechanical ventilation. In PRVC, an increasing compliance will lead to the vent decreasing pressure to assure delivery of desired tidal volume. The POTENTIAL problem here though is that your patient's diaphragm is dropping really fast in response to an unsatisfied neural drive to breathe. The patient is either volume or flow hungry, but has no control over either. So their neural drive says breathe harder. The longer they stay distressed the more distressed they become. The more distressed they become the faster their diaphragm drops. The faster their diaphragm drops the better their compliance is falsely perceived by the vent in PRVC, and the vent incorrectly continues to decrease pressure, which in PRVC decreases flow. Which is the exact opposite of really needs to happen. The patient needs more flow, which would require an increase in pressure to increase flow in PRVC. This may also explain why they fail their SBT. Despite blood gas results, the patient is neurally distressed.
How often do you encounter this issue? Do me a favor. Email me a video or image of the scalar graphics (pressure, flow, volume) the next time you encounter this. Also, assess your patient's P0.1 (aka P100 or occlusion pressure). I would be shocked if wasn't excessively high. Your scenario here has intrigued me. Please keep me up to date as you figure this out. Hope this helped a little. I wish I could give you an absolute answer of what is going on, but without being in front of the patient and vent, I can only speculate based on past experiences and principles of mechanical ventilation.
@@RespiratoryCoach sorry didn't mean spontaneous breathe I meant patient triggered breath over set rate. I see all the time for example, patient pulling 500 VT with vc/ac prvc VT set to 380. Based on what prvc does, that pt is pulling those volumes due to his demand (as you stated) and since he's pulling higher than set VT, theres really no way to measure the amount of SUPPORT the patient is actually getting. I see this all the time. My issue is I cant measure any type of numerical support. And the thing is. Sometimes the patient isn't even in distress, they just want a higher VT. I wish I had a good argument as to why that patient needs to be switched to spontaneous mode. I'm a big believer in getting patient to spontaneous mode asap but providers I work with won't change from VC unless they pass sbt. Alot of times I know I could get the example patient mentioned above to look more comfortable on pressure support 10/5 but they say "theres no evidence based information" which unfortunately to my knowledge is true
Maybe try PAV? Not that it's anything greatly different, just another spontaneous mode, but it might shift the discussion from a PSV research based discussion.
@@RespiratoryCoach
PRVC does allow a pt to take a larger Vt without a double trigger. If they do this then the machine will start backing pressure off. If the patient continues to breath above the target volume the pressure the machine delivers will keep dropping.
So the patient is doing the work instead of supporting the paient.
Some vents have a low pressure alarm that will alert us that the patient is not really being supported.
You'll notice a low PIP maybe only 6 to 10 cm above the PEEP.
I try to get them to switch to pressure support if this happens.
BTW PB 840 vents you can turn that alarm off, but remember that the alarm is there for a reason and I reccomend not simply turning it off.
The Dragar cannot be turned off. It makes you deal with the problem.
A tricky mode to use. Must understand some more things even if you want to do it safely.
@@steves8860 Hi Steve. Thanks again for the contribution from a seasoned RT. Yes, fully aware of the patient's ability to receive a larger tidal volume than the target Vt. However, the patient does not have control of I time or flow. So in cases of asynchrony in PRVC, you might have a flow or volume hungry patient generating a larger than target Vt, which is decreasing pressure, and subsequently flow, in order to reduce Vt, but this actually becomes counter productive because the patient is actually wanting more support (flow or volume), not less. Have you seen this?
Great
What should you do if pressures are continuously high in PRVC?
If they're continuously high then it means you either have a airway resistance problem or a alveolar compliance issue and the high pressures are needed to achieve the target tidal volume. If you don't want your pressures to be that high, adjust your pressure limit alarm so that the vent doesn't increase pressure beyond that point. However, something has to give, so when you do so, you understand that your target tidal volume will not be reached. Another thing to note is that you can decrease your target tidal volume, and make up for the volume by increasing your RR. Hope that helps. Thank you for watching and commenting with your question, Marv!
Respiratory Coach, please enlighten me..
The target Vt is set on 280 but VTi and exhaled VT is only 210. Set Rate already on 30. with high peak pressure and plateau pressure.. Blood gases are consistent with severe respiratory acidosis. What could be the possible problem why we never reached our target VT? Already explained to the doctor that the patient has stiff lung, but insisted that the problem is on the ventilator.
Are prvc and vc+ the same thing?
Yes. Both are closed loop, tidal volume targeted pressure control ventilation.
The little RT! Lol
That's the best I know how to explain it. Just makes sense, right?
Please explain about bias flow..?
Is it safe to say the plateau on PRVC would be accurate seeing as it’s still a Volume Control mode?
So, if you're talking about the initial test breath when switching into PRVC, or any other time a test breath is delivered due to suctioning or broken circuit, then yes. That's only because the vent delivers a set Vt at a set flow and performs a insp hold to determine static compliance, which will determine what the very next breath looks like. Other than the test breath, an insp hold will not give you true representation of plateau pressure, because you'll be holding essentially a pressure control breath. Does this answer your question and make sense? Let me know if not and I'll try again. Thanks for asking!
Not sure if I understand what a “test breath” is ....would I be able to tell on the vent when it is given? Or if I hit manual breath will that be a test breath?
@@mariaholivella5058 Yes, you'll be able to tell. The test breath is a volume control breath with a insp pause. So your pressure waveform on the test breath will be a gradual incline with a plateau pressure observed. The purpose of this test breath is to establish a baseline starting point for all subsequent pressure regulated, time cycled breaths. Post test breath, your pressure waveform will become square as the breaths are now pressure regulated and time cycled, as mentioned before. Make sense?
Respiratory Coach
Yes, I understand now. I never heard Inspiratory hold called a “test breath” so it threw me off. But I get it😊
@@RespiratoryCoach
Can you add a video on how to initiate pressure control ventilation
please do prvc ac or simv prvc
Got it! Thanks for watching and placing a request.
6:15 That little RT needs to take a workload
LOL....that little RT is actually busy being a real therapist!! Appreciate the comic relief, Veer!!!
you are god
No, no, absolutely not, just a normal guy with information to share and a willingness to help others. I do thank you for the kind comment and for watching!
My classes are going online now which I hate, but your videos seem to help me understand the basic concept very much which I thank you for.
@@Bibekshrestha3024 Hang in there
Classes will resume as we know them. Just may be a minute. Keep learning and growing as a RT student. You will be an RRT!
Thank you🤝👏🏼
Just say microprocessor.
LOL or that! Thanks for watching Carlos.