scholarly journals Implementation and feasibility of inverse-ratio Airway Pressure Release Ventilation (APRV): Switching from Conventional Ventilation to APRV in Two French ICUs.

2020 ◽  
Author(s):  
Matthieu Koszutski ◽  
Benjamin Pequignot ◽  
Antoine Kimmoun ◽  
Thomas Remen ◽  
Philippe Guerci ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Pressure Support ◽  
Airway Pressure Release Ventilation ◽  
Conventional Ventilation ◽  
University Teaching ◽  
Volume Control ◽  
Mechanically Ventilated ◽  
Pressure Release ◽  
Ventilation Technique ◽  
Pressure Release Ventilation

Abstract Background:To evaluate the switching of patients mechanically ventilated on Pressure Support or Volume Control to inverse-ratio Airway Pressure Release Ventilation (APRV) during the COVID-19 pandemic.Methods:We performed a single-center retrospective observational analysis in two ICUs in a tertiary referral university teaching hospital in France. Were included patients with Covid-19 pneumonia requiring invasive ventilation with a PaO2:FiO2 ratio lower than 200 mmHg who performed a 6-hour trial of inverse-ratio APRV.Results:Seventeen consecutive patients who completed a 6-hour APRV trial in April 2020 were included. Three patients who were unable to be maintained on APRV due to an immediate fall in SpO2 were not included. In 12/17 patients (71%), the increase in PaO2:FiO2 ratio was greater than 20%. Mean (± standard deviation) PaO2:FiO2 ratio increased from 126 (± 28) mmHg to 178 (± 53) mmHg after 6 hours of APRV (p<0.001). Two patients presented a decrease in PaO2:FiO2 ratio after 6 hours of APRV. There was no appearance of significant hemodynamic impairment during APRV and an eventual increase in PaCO2 during the first hour of APRV was managed by increasing the respiratory rate (i.e. shortening T-high) and/or increasing tidal volume (i.e. increasing T-low).Conclusions:Switching from Conventional Ventilation (Pressure Support or Volume Assist Control) to inverse-ratio APRV for a 6-hour period in two ICUs that were not previously familiar with this ventilation technique was well tolerated, and associated with a marked improvement in oxygenation. Further studies evaluating inverse-ratio APRV in acute respiratory failure are warranted.Trial registration:NCT04386369

scholarly journals The Effect of Airway Pressure Release Ventilation on Pulmonary Catheter Readings: Specifically Pulmonary Capillary Wedge Pressure in a Swine Model

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Ahmad M. Slim ◽  
Shaun Martinho ◽  
Jennifer Slim ◽  
Eddie Davenport ◽  
Luadino M. Castillo-Rojas ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
Conventional Ventilation ◽  
Right Atrial ◽  
Swine Model ◽  
Hemodynamic Parameters ◽  
Pressure Release ◽  
Wide Range ◽  
Baseline Values ◽  
Pressure Release Ventilation

Background. Airway pressure release ventilation (APRV) is a mode of mechanical ventilation that theoretically believed to improve cardiac output by lowering right atrial pressure. However, hemodynamic parameters have never been formally assessed.Methods. Seven healthy swine were intubated and sedated. A baseline assessment of conventional ventilation (assist control) and positive end-expiratory pressure (PEEP) of 5 cm H2O was initiated. Ventilator mode was changed to APRV with incremental elevations of CPAP-high from 10 to 35 cm H2O. After a 3-to-5-minute stabilization period, measurements of hemodynamic parameters (PCWP, LAP, and CVP) were recorded at each level of APRV pressure settings.Results. Increasing CPAP caused increased PCWP and LAP measurements above their baseline values. Mean PCWP and LAP were linearly related (LAP = 0.66∗PCWP + 4.5 cm H2O, , and ) over a wide range of high and low CPAP values during APRV. With return to conventional ventilation, PCWP and LAP returned to their baseline values.Conclusion. PCWP is an accurate measurement of LAP during APRV over variable levels of CPAP. However, PCWP and LAP may not be accurate measurements of volume when CPAP is utilized.

Compared to conventional ventilation, airway pressure release ventilation may increase ventilator days in trauma patients

2012 ◽  
Vol 73 (2) ◽  
pp. 507-510 ◽  
Author(s):  
Adrian A. Maung ◽  
Kevin M. Schuster ◽  
Lewis J. Kaplan ◽  
Michael F. Ditillo ◽  
Greta L. Piper ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Airway Pressure Release Ventilation ◽  
Conventional Ventilation ◽  
Trauma Patients ◽  
Pressure Release ◽  
Pressure Release Ventilation

scholarly journals Comparison of Oxygen Cost of Breathing between Pressure-Support Ventilation and Airway Pressure Release Ventilation

2005 ◽  
Vol 33 (2) ◽  
pp. 218-222 ◽  
Author(s):  
M. Uyar ◽  
K. Demirag ◽  
E. Olgun ◽  
I. Cankayali ◽  
A. R. Moral
Keyword(s):  
Pressure Support Ventilation ◽  
Airway Pressure ◽  
Pressure Support ◽  
Airway Pressure Release Ventilation ◽  
University Hospital ◽  
Adaptation Period ◽  
Oxygen Cost ◽  
Support Ventilation ◽  
Pressure Release ◽  
Pressure Release Ventilation

We compared the oxygen cost of breathing between pressure-support ventilation (PSV) and airway pressure release ventilation (APRV). This prospective, randomized, crossover study was conducted in a mixed ICU of a university hospital. Twenty clinically stable and spontaneously breathing patients after long-term mechanical ventilation were included. The patients were randomized to start on either PSV or APRV mode and measurements were obtained after an adaptation period of 30 minutes with a PaCO2 between 35–45 mmHg and PaO2 above 60 mmHg. Patients were then switched to the other mode and the same measurements were repeated. Indirect calorimetry was performed during each ventilatory mode for a period of 30 minutes. Oxygen consumption, energy expenditure, CO2 production, and respiratory quotient were measured. The parameters did not differ significantly between the two ventilatory modes, regardless of the patient's randomization. There were no statistically significant differences with regard to respiratory rate, minute volume, and blood gas analysis. All patients tolerated both ventilatory modes without signs of discomfort. PSV and APRV produced similar results in terms of oxygen cost of breathing and other metabolic variables.

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