[nurseabc123]

Originally Posted by VandyNurse714

Then how come you see patients with 2, 3, 4 chest tubes? What you (Ready4CRNA) said about the pleural space makes sense, of course...but now my brain's a-wandering...

To everyone: I guess I'm just wondering then -- Is APRV not being used by your facilities? Highest PEEP theoretically one can use on APRV is 35 cm H20. No concerns of pneumo. It has done wonders for our transplant program.

[ready4crna?]

MSU-
APRV is a different animal altogether. Your P-low is analogous to your "PEEP"- usually 0-5 in APRV. The P-high (35mmHg) is analogous to "CPAP"-the inflation pressure if you will. The danger of pneumo is in higher PEEP because of higher Mean Airway pressures that the chest wall has to work against. (Picture sitting on a super inflated balloon that is laying against sidewalk where the balloon is your lung and the sidewalk+butt=chest wall.) APRV is used to accomodate the decreased compliance of diseased lungs. It is also relatively new to the scene and I believe you will find it used with more frequency in facilities that both have the capability to do it (Newer vents), and practitioners that are comfortable with using new ideas.
And just to make clear- if you truly used 35mmHg of PEEP, the next sound you would hear would be your high pressure alarms followed rapidly by the patients lungs popping.
http://www.aacn.org/pdfLibra.NSF/Fil...e/ci120205.pdf
The above link is to an AACN article that explains APRV far better than I can.

Vandy-
As for multiple chest tubes, I would assume you are asking why more than one would be needed on one side. I'll use a common example-Lets say you have a patient that is post thoracotomy for a wedge resection. The surgeon has created a pneumo and modified the lung anatomy as well. s/he might place one chest tube aimed at the anterior superior apex of the pleural space(where air should accumulate in a slightly inclined supine patient.) and also decide to place another aimed more posterior/inferior (where blood/fluid is more likely to accumulate in a patient.)

[mnurse3139]

ARDS, doc had it at 30 for a day, but then again i wouldnt trust this pulmonologist to collect a sputum sample from me.

[yeSICU]

PEEP of 28 on APRV, but APRV is "special" We use it on all of our post op and trauma pt in our SICU. Works wonders for reducing volutrauma, but from the way I understand it, it is PEEP high... which is different that your classic PEEP. Even throws some expereinced RT's for a loop that haven't worked with it much. Enough so that they are developing an algorithm for vent settings and weaning parameters for the Hemod stable pt vs the Unstable ICU pt...

[CrazyPremed]

I saw 25 in clincals a couple of months ago. ARDS at it's worst. 26 y/o with questionable aspiration pneumonia walked into the ER. He never made it out of the hospital.

CrazyPremed

[ddoosier]

Just recently. My pt had a PEEP of 20 with an open abd.

[gradcare]

Have "walked Peep up to 35 cm H2O as part of recruitment manouver On pt with puritan bennet bilevel [hi peep lo peep]. Short term only however (couple min only) BP tends to go "bye bye" as pts tend to be a little vascularly dry and cant deal with the increased afterload and decreased preload due to the increased pressures.

[CaptGaston]

Vandy, was it a ct patient? Cabgs rountinely have 3. the last being for the pericardial space. Is it a patient with a hemothorax?