Flipping the Vent: The APRV-TCAV Course – The First Iteration: February 26, 2021, 1300-2200.

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.

This course will consist of an afternoon and an evening session, each about 3h. The afternoon will be didactic, and the evening will be in-depth case discussions and will finish with an examination.

Registration: sorry…


The Waiting List: this course filled up in minutes. We have been overwhelmed with requests, and will be planning the recurrent course schedule of the next year in the next few days. We have chosen to favour group registration, as APRV-TCAV almost requires a team approach and buy-in. If you are interested in being on the waiting list for the next available spot(s), please email hospresusconference@gmail.com and let the team know!


Part One – APRV-TCAV Basics (1300-1630)

Part 1: Physiological Principles & Literature (60min)

Part 2: The Settings (30min)

Break (15min)

Sponsor symposium (30min)

Part 3: Managing Ventilation (60min)

Part Two – APRV-TCAV Workshop (1900-2200)

Part 1: Initial Setup (30min)

Part 2: Optimizing & Recruiting (45min)

Break (15min)

Part 3: Weaning & Troubleshooting (45min)

Part 4: Exam & Discussion (60min)

With thanks to our sponsors:

Gold Sponsor
Silver Sponsor

APRV & COVID Respiratory Failure with Spiegel & Farkas. #FOAMed, #FOAMcc

So at our last webinar (still to be edited due to an unfortunate trolling event), we briefly touched on modes of ventilation but really didn’t delve into it very deeply, so, being fortunate enough to know some really smart people, I figured I might gather up these two for a quick chat. They are both known for no-nonsense, out-of-the-box thinking, paired with solid physiological thinking, which in my mind is the only way to approach complex problems and system failure. Plus, with Rory (@EMnerd) and his powerful nihilistic approach, there would be no chance for a whimsical approach, it would have to have a base in physiology, evidence (bedside or literature) or both!

So just as a little brain teaser, I would like anyone reading to think about how many severe respiratory failure syndromes they are aware of that attack the lungs in a predictable volumetric fashion, where one can say, for instance, that consistently, X% of the parenchyma is affected. Kinda hard, huh? Yet, if asked how best to ventilate these patients, most of us who feel we have a good grasp of severe respiratory failure would answer without thinking twice: “lung protective ventilation: good peep and 4-6 ml/kg.” In a lear, confident tone, most likely as well.

Now I would say that only the first part is correct: lung protective ventilation. As to the second part, it would, to me, only hold true with uniform pathology and uniform patients. But I’ll let Rory rant about that himself, it’s far more entertaining!

So here is our chat.

Hope everyone gets something out of it!