Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients

Abstract

Systematic review, level IV.

RETRACTED: Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence

“…Indeed, clinical studies have shown that early application of LV t ventilation with various levels of PEEP signifi cantly reduces the incidence of ARDS, presumably by reducing tissue overdistension in areas of stress concentration and by preventing RACE. 20,24,26,39,40 However, a recent study demonstrated that LV t alone applied to the normal lung during surgery in patients at high risk for developing ARDS was associated with increased mortality 28 and that LV t with high but not low PEEP increased postoperative pulmonary complications. 29 In contrast, Futier et al 26 showed that the combination of LV t , PEEP, and RMs signifi cantly reduced acute respiratory failure and mortality in patients undergoing major surgery.…”

“…24,[31][32][33][34] In other words, protection against the development of ALI is conferred by much more than simply the values of V t , plateau pressure, and PEEP that are used; the durations over which these parameters are applied also determine whether lung injury will progress. Mode acronyms such as APRV or CMV, thus, do not encompass all the features of a mechanical breath that determine its injurious or protective impact because the temporal details of the mechanical breath can be critical to this impact.…”

“…25 ARDS occurrence in trauma patients has also been lessened with early application of airway pressure release ventilation (APRV). 24 …”

“…Given that APRV is superior to CMV for the most severely injured lungs (ie, rescue mode) and that the MBP of APRV is theoretically ideal for minimizing ventilator injury cost function, we chose to study the effi cacy of this mechanical breath at reducing ARDS incidence. We hypothesized that the mechanism by which APRV protected the lung 24,[30][31][32][33][34]44,45 was reduced alveolar microstrain ( m -strain). We found that appropriately set APRV with an extended duration at plateau pressure (duration at high pressure [THigh]) and a very brief duration at pressure release (duration at low pressure [TLow]) is essential to minimizing m -strain in the alveoli and the alveolar ducts ( Figs 3 , 4 ).…”

“…[20][21][22][23][24] Multiple studies in patients in the ICU have shown that preemptive protective MV can reduce ARDS incidence. Th is has been shown with conventional MV (CMV) using a combination of LV t , positive endexpiratory pressure (PEEP), and recruitment maneuvers (RMs), 22 including a preemptive randomized clinical trial demonstrating that ARDS incidence can be reduced in high-risk patients in the ICU.…”