Flipping the Vent: The APRV-TCAV Course – Next Course May 20th, 2021, 12pm-3pm (Eastern Standard Time).

You must unlearn everything you have learned…

So for me, the first wave (spring 2020 for Montreal) was the early proving grounds for APRV-TCAV in COVID-19 respiratory failure, and now in the second wave, we are fine-tuning the approach. For Rory Spiegel in Washington, the first wave blended smoothly into the second and he has accumulated a ton of COVID APRV TCAV experience. From our experience, steadily growing since last spring, this is the go-to mode for the vast majority of COVID-19 cases requiring mechanical ventilation.

Dr. Rory Spiegel, Critical Care & Emergency Medicine, Washington Medical Center, Washington, DC, USA.
Dr. Philippe Rola, Chief of Service, Intensive Care Unit, Santa Cabrini Hospital, Montreal, Canada.

At H&R Reloaded, Rory presented “Flipping the Vent,” essentially a conceptual intro to APRV-TCAV, and we ran a small group workshop, which we also did at Haney’s ResusX, which were really enjoyable, and it seems the participants really came away with a lot, but also a lot of questions. So we figured we’d put together a more comprehensive course to give participants a solid base to start using this mode of ventilation.

The first course was essentially held for the Mayo Clinic’s anasthesia/critical care fellows and RTs and included a team from Ireland as well as a handful of individual participants, and was a success. Hence we give it another run!

This course will consist of an online portion (3h core material as well as supplementary material) done at each participant’s convenience, and a live workshop (3h) on the day of the course, but we are adding to the online curriculum, and participants will have ongoing access to the additional material for a year following the course. We are strongly suggesting participants go through at least the core material, because without a reasonable understanding of APRV-TCAV, the workshops will be very difficult to follow and benefit from.

The workshop is the really awesome part of this course, and will mainly feature in-depth case discussions and where we get to the nitty-gritty and review decisions along the course of management of APRV ventilation. This is where the understanding of how to adjust your ventilation as your patient progresses thru different phases of illness, how to escalate or progress to weaning, and how to troubleshoot along the way.

We will finish with an examination to make sure that the concepts have really gotten across.


Coffee or a deep interest in ventilation modes is a must if logging onto this course from Europe – the Q&A piece is in the wee hours!  Attending this course as a group helped us gain confidence to try APRV-TCAV in the difficult to ventilate COVID-19 patient (We have Draeger ventilators but had not used the TCAV version of the mode before with the 75% PEF setting in the “additional settings” part of the vent).  Dr Rola and Dr Spiegel simplified complex concepts. They got us to trouble-shoot problems.  I would recommend this course.” (Dr. Catherine Nix, Anaesthetist-Intensivist)

“Flipping the Vent APRV-TCAV was an excellent introduction to this mode of ventilation, delivered in a practical and useful manner. The rationale is clearly explained at the outset and this is built upon throughout, with discussion around exactly how the ventilator and patient are managed using relevant case scenarios. The expertise of the educators on this course make APRV-TCAV accessible for those unfamiliar with it. I have a better understanding of the practical application of APRV-TCAV having attended this course” Dr Cathal Mac Donncha, Critical Care Fellow.

Registration: due to the rapid sell-out of the last course, we have a long waiting list and we will advise those on it to give them first registration opportunity.

Special Circumstances: we understand that many physicians who may wish to attend and benefit from learning may be in different socio-economic situations, and of registration fee is an issue, please email us at hospresusconference@gmail.com, and we will do our best to accommodate you. Drs. Spiegel and Rola put a high value to knowledge translation and sharing of skills and information.

The Waiting List: please email hospresusconference@gmail.com and let the team you wish to be on the list know in case some spots open up.

Sponsors: we are always looking for sponsors to provide scholarships to physicians or other health care professionals trying to learn. Please contact us if you are able to sponsor one or more!

Schedule (Online module):

Part One – APRV-TCAV Basics (3h) OnLine Module (participants will receive access link with registration)

Core 1: Intro + Physiology

Core 2: Physiological Principles & Literature

Core 3: The Settings

Supplemental: The Low Settings

Supplemental: The Art of the P high

The APRV-TCAV Workshop (3-3.5H)

Part 1: Questions

Part 2: Optimizing & Recruiting (30min)

Part 3: Weaning & Troubleshooting (45min)

Part 4: Exam & Discussion (60min)

With thanks to our sponsors:

COVID-19 Pathophysiology: Are Platelets and Serotonin playing a bigger role than we think? #FOAMed, #FOAMcc

While our general ignorance in medicine has long since stopped surprising me, the COVID-19 pandemic has really highlighted how little we truly know and how unequipped we are to face new diseases. However it has also highlighted an unparalleled degree of collaboration and sharing across the world which has undoubtedly saved many lives.

In this discussion, a very smart and determined friend of mine gives us a masterclass on platelet dysfunction in COVID19 and opens many fascinating potential therapeutic approaches. I think that his outside perspective on the disease – he is a gastroenterologist – gave him a fresh and unbiased approach, and I suspect he is onto something.

Here is the link: https://us02web.zoom.us/rec/share/JlAl-vjLYfvDPJife3yMZo48TF0ZaDCyHIqkV2Z7R-vTpnzXREfiOQE477lTdXCg.Vi1XeeT4OI0I1SuE

And the passcode: @GJ$7rBs

Since recording this I have had a few more cases where I used ciproheptadine, and must admit there was some apparent benefit. While this cannot be conclusive, I do feel it warrants a trial, given the benign nature of the treatment and the not-so-benign nature of the disease!