Test your IntelliVence (Vol 18 Issue 3)

15.07.2021
Author: Aude Garnero, Intensivist, Hôpital Sainte Musse, Toulon, France, Reviewer: Jean-Michel Arnal, Kaouther Saihi, Süha Demirakca

This ARDS patient is ventilated using Adaptive Support Ventilation (ASV®) with PEEP set at 16 cmH2O. There is an alarm associated with the message "Pressure limitation". What does the alarm mean and how can you correct it?

Answer:  The Plimit – the maximum peak pressure to be delivered in ASV mode - is too low.

Ppeak has reached the Plimit; therefore, the target VT calculated by the ASV algorithm can’t be achieved. As the target minute volume set by the clinician is not achieved, ASV increases the respiratory rate up to a certain point. To correct the problem, the clinician should accept a larger pressure difference between PEEP and the Plimit. This can be done by decreasing PEEP or by increasing the Plimit.

In either case, plateau pressure (Pplat) and driving pressure (DP) must be measured in order to ensure lung-protective ventilation (Pplat < 30cmH2O,  DP < 15 cmH2O).

When using ASV, the clinician should set the Plimit higher than Ppeak. This ensures that ASV can still achieve the target VT even in the case of a sudden decrease in compliance (nursing procedure) or an increase in resistance (tube obstruction).

asv, adaptive support ventilation, pressure limitation, alarm, plimit
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Date of Printing: 30.06.2022
Disclaimer:
The content of this newsletter is for informational purposes only and is not intended to be a substitute for professional training or for standard treatment guidelines in your facility. Any recommendations made in this newsletter with respect to clinical practice or the use of specific products, technology or therapies represent the personal opinion of the author only, and may not be considered as official recommendations made by Hamilton Medical AG. Hamilton Medical AG provides no warranty with respect to the information contained in this newsletter and reliance on any part of this information is solely at your own risk.
Date of Printing: 30.06.2022
Disclaimer:
The content of this Knowledge Base is intended for informational purposes only. Medin Medical AG provides no warranty with respect to the information contained in this Knowledge Base and reliance on any part of this information is solely at your own risk. For detailed instructions on operating your Medin Medical device, please refer to the official Medin Medical Operator’s Manual for the respective device.