Utilizing respiratory rate in APRV-TCAV protocol on Puritan Bennett ventilator. A case report

Background Airway Pressure Release Ventilation (APRV), particularly with the Time-Controlled Adaptive Ventilation (TCAV) protocol, is known to improve oxygenation and respiratory mechanics. However, its role in managing refractory hypercapnia remains underexplored. This case report highlights APRV with TCAV as a potential strategy to tackle refractory hypercapnia. Case Report A 43-year-old woman with acute hypoxic and hypercapnic respiratory failure was admitted to our intensive care unit. Over the first 24 hours of management via conventional ventilation modes, she progressed to refractory hypercapnia, leading us to initiate modified APRV settings with TCAV protocol on the Puritan Bennett 980 ventilator (PB 980). This intervention led to rapid improvement in PaCO2, successful transition to PSV, and eventual liberation. Discussion Our literature review revealed limited research on the use of higher controlled respiratory rates in APRV with TCAV. This case demonstrates the potential of this approach, emphasizing the importance of adhering to TCAV principles while optimizing respiratory rate settings. Additionally, we provide insights into APRV titration on the PB 980. Conclusion This report supports the use of APRV with higher controlled respiratory rates, adhering to TCAV protocols, as an effective strategy for managing refractory hypercapnia. Further research is warranted to establish evidence-based guidelines. Keywords: CPAP, Time-Controlled Adaptive Ventilation (TCAV), Refractory Hypercapnia, Ventilation Strategies, Airway Pressure Release Ventilation (APRV)