The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial
Background and objectives: The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. Methods: The study was designed as a randomized, non-blinded, single-center, superiority trial with two...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421001639 |
| _version_ | 1811236740055171072 |
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| author | Mehtap Pehlivanlar Küçük Çağatay Erman Öztürk Nazan Köylü İlkaya Ahmet Oğuzhan Küçük Dursun Fırat Ergül Fatma Ülger |
| author_facet | Mehtap Pehlivanlar Küçük Çağatay Erman Öztürk Nazan Köylü İlkaya Ahmet Oğuzhan Küçük Dursun Fırat Ergül Fatma Ülger |
| author_sort | Mehtap Pehlivanlar Küçük |
| collection | DOAJ |
| description | Background and objectives: The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. Methods: The study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups. Results: Patients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn’t differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2–11) days in the APRV group and 13 (8–81) days in the P-SIMV+PS group (p = 0.019). Conclusions: The APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality. |
| first_indexed | 2024-04-12T12:13:20Z |
| format | Article |
| id | doaj.art-3ace6b61927d4d43b92c0734d1200475 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T12:13:20Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-3ace6b61927d4d43b92c0734d12004752022-12-22T03:33:30ZengElsevierBrazilian Journal of Anesthesiology0104-00142022-01-017212936The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trialMehtap Pehlivanlar Küçük0Çağatay Erman Öztürk1Nazan Köylü İlkaya2Ahmet Oğuzhan Küçük3Dursun Fırat Ergül4Fatma Ülger5Karadeniz Technical University, Faculty of Medicine, Division of Intensive Care Medicine, Department of Chest Diseases, Trabzon, Turkey; Corresponding author.Health Sciences University, Samsun Training and Research Hospital, Clinic of Intensive Care Medicine, Samsun, TurkeyGazi State Hospital, Clinic of Anesthesiology and Reanimation, Samsun, TurkeyKaradeniz Technical University, Faculty of Medicine, Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Trabzon, TurkeyHitit University, Faculty of Medicine, Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Çorum, TurkeyOndokuz Mayıs University, Division of Intensive Care Medicine, Department of Anesthesiology and Reanimation, Samsun, TurkeyBackground and objectives: The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development. Methods: The study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups. Results: Patients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn’t differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2–11) days in the APRV group and 13 (8–81) days in the P-SIMV+PS group (p = 0.019). Conclusions: The APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality.http://www.sciencedirect.com/science/article/pii/S0104001421001639Acute respiratory distress syndromeAPRV ventilation modeBi-level continuous positive airway pressure, intensive care unitVentilation modes |
| spellingShingle | Mehtap Pehlivanlar Küçük Çağatay Erman Öztürk Nazan Köylü İlkaya Ahmet Oğuzhan Küçük Dursun Fırat Ergül Fatma Ülger The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial Brazilian Journal of Anesthesiology Acute respiratory distress syndrome APRV ventilation mode Bi-level continuous positive airway pressure, intensive care unit Ventilation modes |
| title | The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial |
| title_full | The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial |
| title_fullStr | The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial |
| title_full_unstemmed | The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial |
| title_short | The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial |
| title_sort | effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome a randomized controlled trial |
| topic | Acute respiratory distress syndrome APRV ventilation mode Bi-level continuous positive airway pressure, intensive care unit Ventilation modes |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421001639 |
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