Airway pressure release ventilation

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19 papers 0 to 25 followers
Hermann Wrigge, Jörg Zinserling, Peter Neumann, Jerome Defosse, Anders Magnusson, Christian Putensen, Göran Hedenstierna
BACKGROUND: Experimental and clinical studies have shown reduction in intrapulmonary shunt with improved oxygenation by spontaneous breathing with airway pressure release ventilation (APRV) in acute lung injury. The mechanisms of these findings are not clear. The authors hypothesized that spontaneous breathing results in better aeration of lung tissue and that improvement in oxygenation can be explained by these changes. This hypothesis was studied in a porcine model of oleic acid-induced lung injury...
August 2003: Anesthesiology
M Sydow, H Burchardi, E Ephraim, S Zielmann, T A Crozier
A total of 18 patients with acute lung injury (ALI) were sequentially ventilated with two different modes of mechanical ventilation, each applied for a period of 24 h: (1) volume-controlled inverse ratio ventilation (VC-IRV), (2) airway pressure release ventilation (APRV). The individual sequence of both ventilatory modes was randomized. Ventilatory minute volume was adjusted for a PaCO2 of 35 to 45 mm Hg at the beginning of the study during the first ventilatory mode and then kept constant within preset limits...
June 1994: American Journal of Respiratory and Critical Care Medicine
Amyn Hirani, Paul E Marik, Lauren A Plante
BACKGROUND: Airway pressure-release ventilation (APRV) is a novel mode of positive-pressure ventilation that has several advantages over low-tidal-volume, assist-control ventilation in patients with acute respiratory distress syndrome, specifically, lower airway pressures, lower minute ventilation, minimal effects on cardio-circulatory function, ability to spontaneously breathe throughout the entire ventilatory cycle, and decreased sedation requirements. APRV is consistent with lung-protective strategies that aim to limit lung injury associated with mechanical ventilation...
October 2009: Respiratory Care
Timothy R Myers, Neil R MacIntyre
Airway pressure-release ventilation (APRV) is a mechanical ventilation strategy that is usually time-triggered but can be patient-triggered, pressure-limited, and time-cycled. APRV provides 2 levels of airway pressure (P(high) and P(low)) during 2 time periods (T(high) and T(low)), both set by the clinician. APRV usually involves a long T(high) and a short T(low). APRV uses an active exhalation valve that allows spontaneous breathing during both T(high) and T(low). APRV typically generates a higher mean airway pressure with a lower tidal volume (V(T)) and lower positive end-expiratory pressure than comparable levels of other ventilation strategies, so APRV may provide better alveolar recruitment at a lower end-inflation pressure and therefore (1) decrease the risk of barotrauma and alveolar damage in patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS), and (2) provide better ventilation-perfusion matching, cardiac filling, and patient comfort than modes that do not allow spontaneous breaths...
April 2007: Respiratory Care
J Räsänen, R D Cane, J B Downs, J M Hurst, I T Jousela, R R Kirby, H J Rogove, M C Stock
OBJECTIVE: To evaluate the feasibility of airway pressure release ventilation (APRV) in providing ventilatory support to patients with acute lung injury of diverse etiology and mild-to-moderate severity. DESIGN: Prospective, multicenter, nonrandomized crossover trial. SETTING: ICUs in six major referral hospitals. PATIENTS: Fifty adult patients with respiratory failure requiring mechanical ventilation and positive end-expiratory airway pressure...
October 1991: Critical Care Medicine
L J Kaplan, H Bailey, V Formosa
BACKGROUND: The purpose of the present study is to determine whether airway pressure release ventilation (APRV) can safely enhance hemodynamics in patients with acute lung injury (ALI) and/or adult respiratory distress syndrome (ARDS), relative to pressure control ventilation (PCV). METHODS: Patients with severe acute lung injury or ARDS who were managed with inverse-ratio pressure control ventilation, neuromuscular blockade and a pulmonary artery catheter were switched to APRV...
August 2001: Critical Care: the Official Journal of the Critical Care Forum
Eddy Fan, Priyanka Khatri, Pedro A Mendez-Tellez, Carl Shanholtz, Dale M Needham
BACKGROUND: Our objective was to compare sedative and analgesic doses, agents, and sedation status in patients with airway pressure release ventilation (APRV) versus assist-control (AC) ventilation on the first day after acute lung injury diagnosis. METHODS: Observational study at 3 teaching hospitals. RESULTS: Of 240 patients, 165 received APRV or AC ventilation on day 1 (17 APRV, 148 AC). The median Acute Physiology and Chronic Health Evaluation II score was lower in the APRV versus AC group [17 (14-20) vs...
November 2008: Journal of Intensive Care Medicine
Rudolf Hering, Doris Peters, Jörg Zinserling, Hermann Wrigge, Tilman von Spiegel, Christian Putensen
OBJECTIVE: Controlled mechanical ventilation can impair systemic and renal blood flow and function, which may be aggravated by respiratory acidosis. We hypothesized that partial ventilatory support using airway pressure release ventilation (APRV) with spontaneous breathing provides better cardiopulmonary and renal function than full ventilatory support using APRV without spontaneous breathing. DESIGN: Prospective randomized study. SETTING: Intensive care unit of a university hospital...
October 2002: Intensive Care Medicine
Ariel Modrykamien, Robert L Chatburn, Rendell W Ashton
Acute respiratory distress syndrome (ARDS) results in collapse of alveoli and therefore poor oxygenation. In this article, we review airway pressure release ventilation (APRV), a mode of mechanical ventilation that may be useful when, owing to ARDS, areas of the lungs are collapsed and need to be reinflated ("recruited"), avoiding cyclic alveolar collapse and reopening.
February 2011: Cleveland Clinic Journal of Medicine
Adrian A Maung, Lewis J Kaplan
Airway pressure release ventilation (APRV) is an alternative mode of ventilation that is increasingly used in patients with acute respiratory failure, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS). Animal and clinical studies have demonstrated that, compared with conventional ventilation, APRV has beneficial effects on lung recruitment, oxygenation, end-organ blood flow, pulmonary vasoconstriction, and sedation requirements. Further studies, however, are required to directly compare APRV to ARDSnet protocol ventilation, specifically in patients with ALI/ARDS, and to determine whether managing ALI/ARDS with APRV will also achieve mortality reduction...
July 2011: Critical Care Clinics
Robert A Maxwell, John M Green, Jimmy Waldrop, Benjamin W Dart, Philip W Smith, Donald Brooks, Patricia L Lewis, Donald E Barker
BACKGROUND: Airway pressure release ventilation (APRV) is a mode of mechanical ventilation, which has demonstrated potential benefits in trauma patients. We therefore sought to compare relevant pulmonary data and safety outcomes of this modality to the recommendations of the Adult Respiratory Distress Syndrome Network. METHODS: Patients admitted after traumatic injury requiring mechanical ventilation were randomized under a 72-hour waiver of consent to a respiratory protocol for APRV or low tidal volume ventilation (LOVT)...
September 2010: Journal of Trauma
Louise Rose, Martyn Hawkins
OBJECTIVE: The objective of this study was to identify the definitional criteria for the pressure-limited and time-cycled modes: airway pressure release ventilation (APRV) and biphasic positive airway pressure (BIPAP) available in the published literature. DESIGN: Systematic review. METHODS: Medline, PubMed, Cochrane, and CINAHL databases (1982-2006) were searched using the following terms: APRV, BIPAP, Bilevel and lung protective strategy, individually and in combination...
October 2008: Intensive Care Medicine
Krishna M Sundar, Phillip Thaut, David B Nielsen, William T Alward, Michael J Pearce
BACKGROUND: A number of different modalities have been employed in addition to conventional ventilation to improve oxygenation in patients with severe 2009 pandemic influenza A (H1N1) pneumonia. Outcomes with ventilatory and rescue therapies for H1N1 influenza-related acute respiratory distress syndrome (ARDS) have been varied. A single intensive care unit (ICU) experience with management of laboratory-confirmed 2009 pandemic influenza A (H1N1) ARDS with a combination of proning and airway pressure release ventilation (APRV) is described...
May 2012: Journal of Intensive Care Medicine
Richard H Kallet
Airway pressure release ventilation (APRV) and bi-level positive airway pressure (BIPAP) are proposed to reduce patient work of breathing (WOB) sufficiently and to obviate issues related to patient-ventilator synchrony, so that spontaneous breathing can be maintained throughout the course of acute lung injury (ALI). Thus, APRV/BIPAP should reduce requirements for sedation and muscle paralysis, and thereby reduce the duration of mechanical ventilation. Only 17 human, animal, or lung-model studies have examined these claims, either directly or indirectly...
February 2011: Respiratory Care
Allan J Walkey, Sunil Nair, Stella Papadopoulos, Suresh Agarwal, Christine C Reardon
BACKGROUND: Past studies suggest that airway pressure release ventilation (APRV) is associated with reduced sedative requirements and increased recruitment of atelectatic lung, two factors that might reduce the risk for ventilator-associated pneumonia (VAP). We investigated whether APRV might be associated with a decreased risk for VAP in patients with pulmonary contusion. MATERIALS: Retrospective cohort study. RESULTS: Of 286, 64 (22%) patients requiring mechanical ventilation for >48 hours met criteria for pulmonary contusion and were the basis for this study...
March 2011: Journal of Trauma
Ehab G Daoud, Hany L Farag, Robert L Chatburn
Airway pressure release ventilation (APRV) is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation, including alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics, and potential lung-protective effects. It has many claimed disadvantages related to risks of volutrauma, increased work of breathing, and increased energy expenditure related to spontaneous breathing...
February 2012: Respiratory Care
Shreyas Roy, Nader Habashi, Benjamin Sadowitz, Penny Andrews, Lin Ge, Guirong Wang, Preyas Roy, Auyon Ghosh, Michael Kuhn, Joshua Satalin, Louis A Gatto, Xin Lin, David A Dean, Yoram Vodovotz, Gary Nieman
Acute respiratory distress syndrome (ARDS) afflicts 200,000 patients annually with a mortality rate of 30% to 60% despite wide use of low tidal volume (LTV) ventilation, the present standard of care. High-permeability alveolar edema and instability occur early in the development of ARDS, before clinical signs of lung injury, and represent potential targets for therapy. We hypothesize that early application of a protective ventilation strategy (airway pressure release ventilation [APRV]) will stabilize alveoli and reduce alveolar edema, preventing the development of ARDS...
January 2013: Shock
Paul E Marik, Alisha Young, Steve Sibole, Alex Levitov
BACKGROUND: Airway pressure release ventilation (APRV) is an alternative approach to the low-tidal volume "open-lung" ventilation strategy. APRV is associated with a higher mean airway pressure than conventional ventilation and has therefore not been evaluated in patients with acute neurological injuries. METHODS: Case report. RESULTS: We report a patient with severe progressive hypoxemia following a subarachnoid hemorrhage who was converted from pressure-controlled mechanical ventilation to APRV...
October 2012: Neurocritical Care
S P Stawicki, Munish Goyal, Babak Sarani
Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syndrome (ARDS) will die, some from progressive respiratory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory ventilation and airway pressure release ventilation. Both modalities are based on the principles of the open-lung concept and aim to improve oxygenation by keeping the lung uniformly inflated for an extended period of time...
July 2009: Journal of Intensive Care Medicine
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