Airway Pressure Release Ventilation

Davis, Kenneth; Johnson, Daniel J.; Branson, Richard D.; Campbell, Robert S.; Johannigman, Jay A.; Porembka, David T.

doi:10.1001/archsurg.1993.01420240056010

Cited by 39 publications

(23 citation statements)

References 22 publications

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“…As described above, the APRV methodologies were subdivided into two categories: F-APRV; (Tables 1 and 3) and P-APRV (Tables 2 and 4). The majority of the animal studies (69 % of total) [2,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and human studies (82 % of total) [3, were in the F-APRV category.…”

Section: Methodsmentioning

confidence: 99%

“…Stock in 1987 used 60 % CPAP with T Low of 1.27 s and a respiratory rate (RR) of 20 [2]. Davis in 1993 used a similar %CPAP, but decreased the RR by prolonging T High and T Low [3]. Gama de Abreau in 2010 simulated conventional ventilation with a prolonged T Low and short T High [4].…”

Section: How Expiratory Duration Was Personalizedmentioning

confidence: 99%

“…Many crossover trials showed similar or increased oxygenation with lower peak pressures and no negative effect on hemodynamics with APRV as compared with CPPV [2,3,17,[27][28][29][30][31][32][39][40][41][42], and some studies showed hemodynamic improvement with APRV [13,24,36,39]. Prospective randomized trials comparing APRV and CPPV showed that APRV is safe and potentially beneficial (Table 3).…”

Section: Outcomementioning

confidence: 99%

“…1. Indeed, all of these mechanical breaths were defined as APRV [2][3][4][5]. As can be readily seen, the biggest difference between these APRV breaths is the duration at inspiration and expiration.…”

Section: Introductionmentioning

confidence: 99%

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Experiences Using Airway Pressure Release Ventilation for Pneumonia with Severe Hypercapnia or Postoperative Pulmonary Edema

Hong

Lee

2017

Korean J Crit Care Med

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Airway pressure release ventilation (APRV) was first described in 1987 and defined as continuous positive airway pressure (CPAP) with a brief release while allowing the patient to spontaneously breathe throughout the respiratory cycle. The current understanding of the optimal strategy to minimize ventilator-induced lung injury is to "open the lung and keep it open". APRV should be ideal for this strategy with the prolonged CPAP duration recruiting the lung and the minimal release duration preventing lung collapse. However, APRV is inconsistently defined with significant variation in the settings used in experimental studies and in clinical practice. The goal of this review was to analyze the published literature and determine APRV efficacy as a lung-protective strategy. We reviewed all original articles in which the authors stated that APRV was used. The primary analysis was to correlate APRV settings with physiologic and clinical outcomes. Results showed that there was tremendous variation in settings that were all defined as APRV, particularly CPAP and release phase duration and the parameters used to guide these settings. Thus, it was impossible to assess efficacy of a single strategy since almost none of the APRV settings were identical. Therefore, we divided all APRV studies divided into two basic categories: (1) fixed-setting APRV (F-APRV) in which the release phase is set and left constant; and (2) personalized-APRV (P-APRV) in which the release phase is set based on changes in lung mechanics using the slope of the expiratory flow curve. Results showed that in no study was there a statistically significant worse outcome with APRV, regardless of the settings (F-ARPV or P-APRV). Multiple studies demonstrated that P-APRV stabilizes alveoli and reduces the incidence of acute respiratory distress syndrome (ARDS) in clinically relevant animal models and in trauma patients. In conclusion, over the 30 years since the mode's inception there have been no strict criteria in defining a mechanical breath as being APRV. P-APRV has shown great promise as a highly lung-protective ventilation strategy.

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Section: Methodsmentioning

confidence: 99%

Section: How Expiratory Duration Was Personalizedmentioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Experiences Using Airway Pressure Release Ventilation for Pneumonia with Severe Hypercapnia or Postoperative Pulmonary Edema

Hong

Lee

2017

Korean J Crit Care Med

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“…If a standard APRV frequency of 8 -15 cycles/min is used, 3,12,[35][36][37][38] then a substantial amount of V E could be shifted abruptly to the patient. This could result in an acute rise in arterial carbon dioxide level and a marked increase in respiratory drive, WOB, and respiratory muscle power output.…”

Section: Minute Ventilation Supportmentioning

confidence: 99%

Patient-Ventilator Interaction During Acute Lung Injury, and the Role of Spontaneous Breathing: Part 2: Airway Pressure Release Ventilation

Kallet

2011

Respir Care

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Airway pressure release ventilation (APRV) and bi-level positive airway pressure (BIPAP) are proposed to reduce patient work of breathing (WOB) sufficiently and to obviate issues related to patient-ventilator synchrony, so that spontaneous breathing can be maintained throughout the course of acute lung injury (ALI). Thus, APRV/BIPAP should reduce requirements for sedation and muscle paralysis, and thereby reduce the duration of mechanical ventilation. Only 17 human, animal, or lung-model studies have examined these claims, either directly or indirectly. Most did not target patients with ALI. Studies on sedation use have serious methodological limitations. Other studies found that APRV/BIPAP either increased WOB and asynchrony, or had no effect on energy expenditure. To supplement the discussion of patient WOB during APRV/BIPAP in ALI, 4 clinical examples showed marked elevation and wide variation in patient WOB. One plausible explanation is that spontaneous breathing is superimposed upon the mechanical ventilation pattern. Thus a variety of "breathing environments" exist during APRV/BIPAP that affect patient WOB and respiratory drive differently and perhaps unpredictably. This characteristic of APRV/BIPAP makes WOB comparisons with traditional modes problematic. Furthermore, the theoretical benefits of APRV, in terms of controlling patient WOB, appear particularly limited when lung-protective 190RESPIRATORY CARE

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