NON-INVASIVE VENTILATION WITH AVERAGE VOLUME-ASSURED PRESSURE SUPPORT FOR ACUTE HYPERCAPNIC RESPIRATORY FAILURE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Average volume-assured pressure support (AVAPS) is a comparatively newer modality of non-invasive ventilation that incorporates the properties both volume and pressure-control ventilation. Though its benefits were well documented in chronic respiratory failure, studies illustrating usage acute failure are still insubstantial. Herein, we aim to showcase utility AVAPS management on hypercapnic failure. CASE PRESENTATION: An 80-year-old female with body mass index (BMI) 37 kg/m2 opiate use presented Emergency Department (ED) following two-day history increasing shortness breath confusion. Her medical was notable for hypersensitivity pneumonitis secondary bird exposure, former smoker, paroxysmal atrial fibrillation, recent pericarditis which she taking aspirin colchicine. arterial blood gas (ABG) showed pH 7.14, PaCO2 124 mmHg (FiO2 28%), PaO2 94 mmHg, bicarbonate 41 mmol/L. A chest x-ray increased bilateral interstitial infiltrates. The patient received IV methylprednisolone placed Spontaneous/Timed mode Bilevel positive airway (BiPAP S/T) an Inspiratory (IPAP) 10 Expiratory (EPAP) 5 rate 12/min. At these set pressures, her inspired tidal volumes around 400ml. continued remain confused (GCS 12/15) thus, switched average target 500ml. With this modality, displayed rapid improvement symptoms ABG drawn eight hours after initiation revealed 7.34, 66 135 50%), 34 discharged home 5th day admission. DISCUSSION: intelligent gives us option maximum minimum IPAP, place one fixed IPAP setting, along volume. ventilator automatically adjusts inspiratory within range ensure delivery pre-set Patient-ventilator dyssynchronization prevented previous have reported better comfort satisfaction AVAPS, thereby, improving compliance treatment. shown be superior BiPAP S/T associated values GCS score patients complicated encephalopathy <10/15). CONCLUSIONS: Our case highlights valuable how, certain clinical situations, it may preferred first-line over standard treatment REFERENCE #1: Yarrarapu SNS, Saunders H, Sanghavi D. Volume-Assured Pressure Support. 2021 Jan 5. In: StatPearls [Internet]. Treasure Island (FL): Publishing; Jan–. PMID: 32809435. DISCLOSURES: No relevant relationships by Pramod Guru, source=Web Response Devang Sanghavi, Hollie Saunders, Siva Naga Yarrarapu,