Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure
Background Airway pressure release ventilation (APRV) is defined as ventilation modality with triggered time, limited pressure, and cycled time. In this mode, the pressure altered from a high level applied for a prolonged time to maintain adequate lung volumes and alveolar recruitment, to a low leve...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Egyptian Journal of Chest Disease and Tuberculosis |
| Subjects: | |
| Online Access: | http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2022;volume=71;issue=1;spage=74;epage=80;aulast=Ibrahim |
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| author | Rafaat Talaat Ibrahim Yaser Ahmed Mohamed Mohamed Saad Abd El-kader Ahmed Metwally Azouz |
| author_facet | Rafaat Talaat Ibrahim Yaser Ahmed Mohamed Mohamed Saad Abd El-kader Ahmed Metwally Azouz |
| author_sort | Rafaat Talaat Ibrahim |
| collection | DOAJ |
| description | Background Airway pressure release ventilation (APRV) is defined as ventilation modality with triggered time, limited pressure, and cycled time. In this mode, the pressure altered from a high level applied for a prolonged time to maintain adequate lung volumes and alveolar recruitment, to a low level for a short period of time that allows efficient ventilation and CO2 removal.
Patients and methods Patients with acute hypoxemic respiratory failure were mechanically ventilated, and then, shifted to either synchronized intermittent mandatory ventilation, pressure control (group I) or to APRV (group II). The following parameters were monitored and compared: arterial blood gas measurements, hemodynamic, respiratory mechanics, peak pressure, plateau pressure, mean airway pressure, compliance, minute ventilation, indices of hemodynamic, and tissue perfusion.
Results This study involved 60 mechanically ventilated patients. Our study demonstrated no significant difference between both groups regarding demographic data. We found that APRV group have better hemodynamic, better oxygenation, lower need for sedation and vasopressors, higher cardiac index, and higher estimated glomerular filtration rate. ICU scores were comparable in both groups, whereas lung injury score significantly decreased with APRV mode in APRV group. Decreased duration of mechanical ventilation, ICU stay, hospital stay, less complication risk, and less mortality rate were seen with APRV mode.
Conclusion The early application of APRV in patients with acute severe hypoxemic respiratory failure was associated with better hemodynamic, better oxygenation, better respiratory mechanics, less sedation use, better perfusion, lower risk of complication, and a shorter duration of ICU stay. Future research should compare APRV strategies to assign the best management approach. |
| first_indexed | 2024-04-11T17:24:24Z |
| format | Article |
| id | doaj.art-4984546f18874674bc264d9c7148a7e5 |
| institution | Directory Open Access Journal |
| issn | 0422-7638 2090-9950 |
| language | English |
| last_indexed | 2024-04-11T17:24:24Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Egyptian Journal of Chest Disease and Tuberculosis |
| spelling | doaj.art-4984546f18874674bc264d9c7148a7e52022-12-22T04:12:23ZengWolters Kluwer Medknow PublicationsEgyptian Journal of Chest Disease and Tuberculosis0422-76382090-99502022-01-01711748010.4103/ejcdt.ejcdt_82_20Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failureRafaat Talaat IbrahimYaser Ahmed MohamedMohamed Saad Abd El-kaderAhmed Metwally AzouzBackground Airway pressure release ventilation (APRV) is defined as ventilation modality with triggered time, limited pressure, and cycled time. In this mode, the pressure altered from a high level applied for a prolonged time to maintain adequate lung volumes and alveolar recruitment, to a low level for a short period of time that allows efficient ventilation and CO2 removal. Patients and methods Patients with acute hypoxemic respiratory failure were mechanically ventilated, and then, shifted to either synchronized intermittent mandatory ventilation, pressure control (group I) or to APRV (group II). The following parameters were monitored and compared: arterial blood gas measurements, hemodynamic, respiratory mechanics, peak pressure, plateau pressure, mean airway pressure, compliance, minute ventilation, indices of hemodynamic, and tissue perfusion. Results This study involved 60 mechanically ventilated patients. Our study demonstrated no significant difference between both groups regarding demographic data. We found that APRV group have better hemodynamic, better oxygenation, lower need for sedation and vasopressors, higher cardiac index, and higher estimated glomerular filtration rate. ICU scores were comparable in both groups, whereas lung injury score significantly decreased with APRV mode in APRV group. Decreased duration of mechanical ventilation, ICU stay, hospital stay, less complication risk, and less mortality rate were seen with APRV mode. Conclusion The early application of APRV in patients with acute severe hypoxemic respiratory failure was associated with better hemodynamic, better oxygenation, better respiratory mechanics, less sedation use, better perfusion, lower risk of complication, and a shorter duration of ICU stay. Future research should compare APRV strategies to assign the best management approach.http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2022;volume=71;issue=1;spage=74;epage=80;aulast=Ibrahimairway pressure release ventilationacute respiratory distress syndromehypoxemic respiratory failuremechanical ventilation |
| spellingShingle | Rafaat Talaat Ibrahim Yaser Ahmed Mohamed Mohamed Saad Abd El-kader Ahmed Metwally Azouz Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure Egyptian Journal of Chest Disease and Tuberculosis airway pressure release ventilation acute respiratory distress syndrome hypoxemic respiratory failure mechanical ventilation |
| title | Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure |
| title_full | Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure |
| title_fullStr | Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure |
| title_full_unstemmed | Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure |
| title_short | Airway pressure release ventilation versus pressure-controlled ventilation in acute hypoxemic respiratory failure |
| title_sort | airway pressure release ventilation versus pressure controlled ventilation in acute hypoxemic respiratory failure |
| topic | airway pressure release ventilation acute respiratory distress syndrome hypoxemic respiratory failure mechanical ventilation |
| url | http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2022;volume=71;issue=1;spage=74;epage=80;aulast=Ibrahim |
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