Podcast 189 - APRV & Volumetric CO2 w/ Joe Hylton

In this episode of the FOAMfrat Podcast, we sit down with Joe Hylton, one of the go-to ventilator educators in critical care transport, to break down APRV in a way that actually makes sense.

We move beyond surface level explanations and get into how APRV really works, why it is so effective for ARDS and severe hypoxemia, and how volumetric capnography can give you real-time physiologic feedback when titrating mean airway pressure and PEEP.

This is not a "set it and forget it" APRV discussion. We dig into the mechanics, the physiology, and the bedside decision making that matters in transport and critical care environments.

Topics covered in this episode:
• How APRV differs from conventional pressure control ventilation
• Why mean airway pressure is the real driver of recruitment
• Using flow curves and time constants instead of guesswork
• Volumetric CO₂ vs end-tidal CO₂ and why the difference matters
• Identifying optimal recruitment and overdistension in real time
• How VĊO₂ trends can guide PEEP and pressure adjustments
• APRV pitfalls, misconceptions, and when paralysis may still make sense
• Practical APRV setup on Hamilton ventilators for transport teams

If APRV has ever felt like ventilator voodoo, this episode pulls the curtain back and ties the mechanical settings to what is actually happening at the alveolar and capillary level.

Joe brings deep experience from working with Hamilton Medical systems, and the discussion is framed through real-world transport and ICU decision making, including insights relevant to teams like Life Link III and other critical care programs.

This episode is ideal for:
• Flight paramedics and critical care transport clinicians
• ICU nurses and respiratory therapists
• Medical directors and educators
• Anyone who wants to understand APRV beyond memorized settings

🎧 Listen, learn, and rethink how you approach lung recruitment.

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