Characteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study.
BACKGROUND
The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. The goal of this study was to describe the clinical and physiological effects of APRV in patients with established ARDS.


METHODS
This retrospective observational study was performed in a 23-bed adult intensive care unit in a tertiary extracorporeal membrane oxygenation (ECMO) referral centre. Patients with ARDS based on Berlin criteria were included through a prospectively-collected APRV database. Patients receiving APRV for less than six hours were excluded.


RESULTS
Fifty patients fulfilled the eligibility criteria. Prior to APRV initiation, median Murray Lung Injury Score was 3.5 (interquartile range (IQR) 2.5-3.9) and PaO2/FiO2 was 99mmHg (IQR 73-137). PaO2/FiO2 significantly improved within twenty-four hours post-APRV initiation (ANOVA F(1, 27)=24.34, P<.005). Two patients (4%) required intercostal catheter insertion for barotrauma. Only one patient (2%) required ECMO after APRV initiation, despite a majority (68%) fulfilling previously established criteria for ECMO at baseline. Hospital mortality rate was 38%.


CONCLUSIONS
In patients with ARDS-related refractory hypoxaemia treated with APRV, an early and sustained improvement in oxygenation, low incidence of clinically significant barotrauma and progression to ECMO was observed. The safety and efficacy of APRV requires further consideration.
['Lim|Jolene|J|', 'Litton|Edward|E|', 'Robinson|Hayley|H|', 'Das Gupta|Mike|M|']
D000328:Adult D001469:Barotrauma D002245:Carbon Dioxide D045422:Continuous Positive Airway Pressure D015199:Extracorporeal Membrane Oxygenation D005260:Female D017052:Hospital Mortality D006801:Humans D006863:Hydrogen-Ion Concentration D000860:Hypoxia D007362:Intensive Care Units D008297:Male D008875:Middle Aged D010100:Oxygen D010313:Partial Pressure D012128:Respiratory Distress Syndrome D012189:Retrospective Studies D016896:Treatment Outcome
Airway pressure release ventilation acute respiratory distress syndrome ECMO mechanical ventilation