Why All the Shots at Airway Pressure Release Ventilation When Conventional Ventilation Doesn't Have Consensus?

Light, Aaron

doi:10.4187/respcare.05980

Cited by 2 publications

(2 citation statements)

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“…In agreement with this, it has been conclusively shown that the absence of randomized controlled trials is the primary impediment to the use of APRV in patients with ARDS [ 17 , 18 , 32 ]. A lack of consensus among practitioners in the initiation and management of APRV settings has been noted, which can be attributed to the absence of solid proof supporting the application of APRV placement [ 22 , 33 ]. In light of the aforementioned findings, it is highly recommended to establish a training program and implement an institutional policy to improve nursing staff’s knowledge of the effective way to use APRV.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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show abstract

“…We thank Dr Light for his insights on airway pressure release ventilation (APRV) 1 and will address his comments one by one below. However, we first re-emphasize that the purpose of our study 2 was not to address the clinical value of APRV-that can only be accomplished with randomized clinical trials.…”

Section: Airway Pressure Release Ventilation Letter-replymentioning

confidence: 99%