scholarly journals Utilization of Airway Pressure Release Ventilation as a Rescue Strategy in COVID-19 Patients: A Retrospective Analysis

2021 ◽  
pp. 088506662110308
Author(s):  
Omar Mahmoud ◽  
Deep Patadia ◽  
James Salonia
Keyword(s):  
Retrospective Analysis ◽  
Airway Pressure ◽  
Minute Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Airway Pressure Release Ventilation ◽  
Inspiratory Time ◽  
Predicted Body Weight ◽  
Pressure Release ◽  
Refractory Hypoxemia ◽  
Pressure Release Ventilation

Background: Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by prolonged inspiratory time and high mean airway pressure. Several studies have demonstrated that APRV can improve oxygenation and lung recruitment in patients with Acute Respiratory Distress Syndrome (ARDS). Although most patients with COVID-19 meet the Berlin criteria for ARDS, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. To date, no studies investigating APRV in this patient population have been published. The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia. Methods: We conducted a retrospective analysis of patients admitted with COVID-19 requiring invasive mechanical ventilation who were treated with a trial of APRV for refractory hypoxemia. PaO2/FIO2 (P/F ratio), ventilatory ratio and ventilation outputs before and during APRV were compared. Results: APRV significantly improved the P/F ratio and decreased FIO2 requirements. PaCO2 and ventilatory ratio were also improved. There was an increase in tidal volume per predicted body weight during APRV and a decrease in total minute ventilation. On multivariate analysis, higher inspiratory to expiratory ratio (I: E) and airway pressure were associated with greater improvement in P/F ratio. Conclusions: APRV may improve oxygenation, alveolar ventilation and CO2 clearance in patients with COVID-19 and refractory hypoxemia. These effects are more pronounced with higher airway pressure and inspiratory time.

scholarly journals Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies

2020 ◽  
Vol 14 ◽  
pp. 117954842090329
Author(s):  
Andrew S Fredericks ◽  
Matthew P Bunker ◽  
Louise A Gliga ◽  
Callie G Ebeling ◽  
Jenny RB Ringqvist ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Animal Studies ◽  
Outcome Data ◽  
Airway Pressure Release Ventilation ◽  
Management Approach ◽  
Pressure Release ◽  
Refractory Hypoxemia ◽  
Data Source ◽  
Management Approaches ◽  
Pressure Release Ventilation

Objective: To review the theoretical benefits of airway pressure release ventilation (APRV), summarize the evidence for its use in clinical practice, and discuss different titration strategies. Data Source: Published randomized controlled trials in humans, observational human studies, animal studies, review articles, ventilator textbooks, and editorials. Data Summary: Airway pressure release ventilation optimizes alveolar recruitment, reduces airway pressures, allows for spontaneous breathing, and offers many hemodynamic benefits. Despite these physiologic advantages, there are inconsistent data to support the use of APRV over other modes of ventilation. There is considerable heterogeneity in the application of APRV among providers and a shortage of information describing initiation and titration strategies. To date, no direct comparison studies of APRV strategies have been performed. This review describes 2 common management approaches that bedside providers can use to optimally tailor APRV to their patients. Conclusion: Airway pressure release ventilation remains a form of mechanical ventilation primarily used for refractory hypoxemia. It offers unique physiological advantages over other ventilatory modes, and providers must be familiar with different titration methods. Given its inconsistent outcome data and heterogeneous use in practice, future trials should directly compare APRV strategies to determine the optimal management approach.

HIGH FREQUENCY PERCUSSIVE VENTILATION CAN MIMIC AIRWAY PRESSURE RELEASE VENTILATION IN A TEST LUNG MODEL

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A38
Author(s):  
Faera L Byerly ◽  
Bruce A Cairns ◽  
Kathy A Short ◽  
John A Haithcock ◽  
Lynn Shapiro ◽  
...  
Keyword(s):  
High Frequency ◽  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
Lung Model ◽  
Test Lung ◽  
Pressure Release ◽  
Pressure Release Ventilation

scholarly journals An assessment of esophageal balloon use for the titration of airway pressure release ventilation and controlled mechanical ventilation in a patient with extrapulmonary acute respiratory distress syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Óscar Arellano-Pérez ◽  
Felipe Castillo Merino ◽  
Roberto Torres-Tejeiro ◽  
Sebastián Ugarte Ubiergo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Transpulmonary Pressure ◽  
Airway Pressure Release Ventilation ◽  
Pressure Release ◽  
Esophageal Balloon ◽  
Pressure Release Ventilation

Abstract Background Esophageal pressure measurement is a minimally invasive monitoring process that assesses respiratory mechanics in patients with acute respiratory distress syndrome. Airway pressure release ventilation is a relatively new positive pressure ventilation modality, characterized by a series of advantages in patients with acute respiratory distress syndrome. Case presentation We report a case of a 55-year-old chilean female, with preexisting hypertension and recurrent renal colic who entered the cardiosurgical intensive care unit with signs and symptoms of urinary sepsis secondary to a right-sided obstructive urolithiasis. At the time of admission, the patient showed signs of urinary sepsis, a poor overall condition, hemodynamic instability, tachycardia, hypotension, and needed vasoactive drugs. Initially the patient was treated with volume control ventilation. Then, ventilation was with conventional ventilation parameters described by the Acute Respiratory Distress Syndrome Network. However, hemodynamic complications led to reduced airway pressure. Later she presented intraabdominal hypertension that compromised the oxygen supply and her ventilation management. Considering these records, an esophageal manometry was used to measure distending lung pressure, that is, transpulmonary pressure, to protect lungs. Initial use of the esophageal balloon was in a volume-controlled modality (deep sedation), which allowed the medical team to perform inspiratory and expiratory pause maneuvers to monitor transpulmonary plateau pressure as a substitute for pulmonary distension and expiratory pause and determine transpulmonary positive end-expiratory pressure. On the third day of mechanical respiration, the modality was switched to airway pressure release ventilation. The use of airway pressure release ventilation was associated with reduced hemodynamic complications and kept transpulmonary pressure between 0 and 20 cmH2O despite a sustained high positive end-expiratory pressure of 20 cmH2O. Conclusion The application of this technique is shown in airway pressure release ventilation with spontaneous ventilation, which is then compared with a controlled modality that requires a lesser number of sedative doses and vasoactive drugs, without altering the criteria for lung protection as guided by esophageal manometry.

scholarly journals Airway pressure release ventilation during ex vivo lung perfusion attenuates injury

2017 ◽  
Vol 153 (1) ◽  
pp. 197-204 ◽  
Author(s):  
J. Hunter Mehaffey ◽  
Eric J. Charles ◽  
Ashish K. Sharma ◽  
Dustin T. Money ◽  
Yunge Zhao ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Airway Pressure Release Ventilation ◽  
Ex Vivo Lung Perfusion ◽  
Pressure Release ◽  
Pressure Release Ventilation
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