The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial

Küçük, Mehtap Pehlivanlar; Öztürk, Çağatay Erman; İlkaya, Nazan Köylü; Küçük, Ahmet; Ergül, Dursun Fırat; Ülger, Fatma

doi:10.1016/j.bjane.2021.03.022

Cited by 2 publications

(4 citation statements)

References 31 publications

(41 reference statements)

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“…We included 9 cohort studies, 10 randomized controlled trials, and one cross-over study (Table 1) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. The average number of participants from randomized controlled trials was 37 while the average number of participants from cohort studies was 22.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis

Lutz,

Charlamb,

Kenna

et al. 2024

JCM

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Airway pressure release ventilation (APRV) is a protective mechanical ventilation mode for patients with acute respiratory distress syndrome (ARDS) that theoretically may reduce ventilator-induced lung injury (VILI) and ARDS-related mortality. However, there is no standard method to set and adjust the APRV mode shown to be optimal. Therefore, we performed a meta-regression analysis to evaluate how the four individual APRV settings impacted the outcome in these patients. Methods: Studies investigating the use of the APRV mode for ARDS patients were searched from electronic databases. We tested individual settings, including (1) high airway pressure (PHigh); (2) low airway pressure (PLow); (3) time at high airway pressure (THigh); and (4) time at low pressure (TLow) for association with PaO2/FiO2 ratio and ICU length of stay. Results: There was no significant difference in PaO2/FiO2 ratio between the groups in any of the four settings (PHigh difference −12.0 [95% CI −100.4, 86.4]; PLow difference 54.3 [95% CI −52.6, 161.1]; TLow difference −27.19 [95% CI −127.0, 72.6]; THigh difference −51.4 [95% CI −170.3, 67.5]). There was high heterogeneity across all parameters (PhHgh I2 = 99.46%, PLow I2 = 99.16%, TLow I2 = 99.31%, THigh I2 = 99.29%). Conclusions: None of the four individual APRV settings independently were associated with differences in outcome. A holistic approach, analyzing all settings in combination, may improve APRV efficacy since it is known that small differences in ventilator settings can significantly alter mortality. Future clinical trials should set and adjust APRV based on the best current scientific evidence available.

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis

Lutz,

Charlamb,

Kenna

et al. 2024

JCM

View full text Add to dashboard Cite

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“…It also allows for spontaneous respiratory effort at any CPAP intensity. It is seen as a potentially life-saving method for patients suffering from acute respiratory distress syndrome (ARDS) who are struggling to maintain oxygenation [ 3 ]. APRV is a safe and effective technique for breathing that is pressure-limited, time-triggered, and time-cycled [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…APRV has been found to give lower peak pressure, better oxygenation, less circulatory loss, and better gas exchange than conventional ventilation, without worsening the ARDS patient’s hemodynamic status [ 5 ]. This method is thought to aid in the goal of recruiting consolidated lung regions and preventing recurrent opening and closing of the alveoli (decruitment) [ 3 ]. Research has demonstrated that, when compared to other ventilation modes in ARDS patients, the APRV mode increased gas exchange and arterial oxygenation (PaO 2 /FiO 2 ) ratios [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Research has demonstrated that, when compared to other ventilation modes in ARDS patients, the APRV mode increased gas exchange and arterial oxygenation (PaO 2 /FiO 2 ) ratios [ 6 , 7 ]. Previous literature has elucidated that the timely implementation of APRV in adult patients with ARDS is associated with improvements in oxygenation status, respiratory compliance, and a reduction in the duration of both mechanical ventilation and intensive care unit (ICU) stays [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Awareness and practice of airway pressure release ventilation mode in acute respiratory distress syndrome patients among nurses in Saudi Arabia

Aldhahir,

Alqarni,

Madkhali

et al. 2024

BMC Nurs

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Background This study aimed to assess the knowledge and current practice of using the airway pressure release ventilation (APRV) mode with acute respiratory distress syndrome (ARDS) patients and identify barriers to not using this mode of ventilation among nurses who work in critical areas in Saudi Arabia. Methods Between December 2022 and April 2023, a cross-sectional online survey was disseminated to nurses working in critical care areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results Overall, 1,002 nurses responded to the online survey, of whom 592 (59.1%) were female. Only 248 (24.7%) nurses had ever used APRV mode, whereas only 229 (22.8%) received training on APRV mode. Moreover, 602 (60.0%) nurses did not know whether APRV was utilized in their hospital. Additionally, 658 (65.6%) nurses did not know whether APRV mode was managed using a standard protocol. Prone positioning was the highest recommended intervention by 444 (43.8%) when a conventional MV failed to improve oxygenation in patients with ARDS. 323 (32.2%) respondents stated that the P-high should be set equal to the plateau pressure on a conventional ventilator, while 400 (39.9%) said that the P-low should match PEEP from a conventional ventilator. Almost half of the respondents (446, 44.5%) stated that the T-high should be set between 4 and 6 s, while 415 (41.4%) said that the T-low should be set at 0.4 to 0.8 s. Over half of the nurses (540, 53.9%) thought that the maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, 475 (47.4%) believed that the maximum allowed P-high setting should be 35 cm H2O. One-third of the responders (329, 32.8%) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cm H2O. However, 444 (44.3%) thought that the T-high should be gradually increased to reach a target of 10 s. Half of the responders (556, 55.5%) felt that the criteria to switch the patient to continuous positive airway pressure (CPAP) were for the patient to have an FiO2 ≤ 0.4, P-high ≤ 10 cm H2O, and T-high ≥ 10 s. Lack of training was the most common barrier to not using APRV by 615 (61.4%). Conclusion The majority of nurses who work in critical care units have not received sufficient training in APRV mode. A significant discrepancy was observed regarding the clinical application and management of APRV parameters. Inadequate training was the most frequently reported barrier to the use of APRV in patients with ARDS.

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The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial

Cited by 2 publications

References 31 publications

Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis

Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis

Awareness and practice of airway pressure release ventilation mode in acute respiratory distress syndrome patients among nurses in Saudi Arabia

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