Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.

Omar, Amr; Taha, Adel; Elmetwally, Tamer; Sivadasan, Praveen; Khalil, Mohamed Abdelhamid

doi:10.21608/jicem.2021.231265

Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.

Document Type : Original papers

Authors

¹ critical care department,faculty of medicine ,Beni-Suef University

² Consultant Intensivist, Critical Care Department, Saqr Hospital, EHS, UAE

³ Associate Professor Anesthesia and Intensive Care, Mansoura University Hospital, Egypt

⁴ 3) Consultant intensivist, heart hospital Hamad medical corporation, Doha, Qatar

⁵ Professor of Anesthesia, Cairo university, Egypt. From the Department of critical care medicine/ Saqr Hospital, EHS, United Arab Emirates

10.21608/jicem.2021.231265

Abstract

Background: High mortality is associated with acute respiratory distress syndrome (ARDS).
Methods: The study was a retrospective observational study on 39 patients with moderate to severe ARDS admitted between July 2010 and January 2013. Criteria for transition to Airway Pressure Release Ventilation (APRV) included

failure to wean down FiO2 below 60% after 24 hours,
hemodynamic instability due to high positive end-expiratory pressure (PEEP), and
failure to maintain plateau airway pressure below 30 cm H2O.

We compared the outcome of mandatory ventilation (CMV) and APRV groups with particular concern to the duration of mechanical ventilation, the requirement for tracheostomy, the requirement for vasopressors, and survival to ICU discharge.
Results: Twenty-four males and 15 females were included in the study with a mean age of 42 years (±24). Fourteen out of them fulfilled the criteria and were shifted to APRV within 24 hours of initiating mechanical ventilation. Ten out of 14 (70%) patients in the APRV arm survived ICU discharge versus 16 out of 25 (64%) patients in the CMV group (p 0.45). Survivors in the APRV group spent significantly shorter periods on mechanical ventilation than survivors in the CMV group (9.6 vs 12.1 days, p 0.03). Furthermore, APRV patients required significantly fewer tracheostomies and less vasopressor.
Conclusions:
We concluded that APRV could be effectively used as a rescue mode of ventilation in patients with severe ARDS. Although our study does not show any mortality benefit of using APRV over CMV, there were shorter ventilation days and ICU stay days using APRV.

Keywords

References

McCallum NS, Evans TW. Epidemiology of acute lung injury. Curr Opin Crit Care 2005; 11: 43-9
Kamp R, Sun X, Garcia JG. Making genomics functional: deciphering the genetics of acute lung injury. Proc Am Thorac Soc 2008; 5: 348-53 1.
Habashi NM. Other approaches to open-lung ventilation: Airway pressure release ventilation. Crit Care Med. 2005;33:S228–40.
Katz JA, Marks JD. Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. 1985;63:598–607.
Downs JB, Stock MC. Airway pressure release ventilation: A new concept in ventilatory support. Crit Care Med. 1987;15:459–61.
Hotchkiss JR, Jr, Blanch L, Murias G, Adams AB, Olson DA, Wangensteen OD, et al. Effects of decreased respiratory frequency on ventilator-induced lung injury. Am J Respir Crit Care Med. 2000;161:463–8.
Stock MC, Downs JB, Frolicher DA. Airway pressure release ventilation. Crit Care Med. 1987;15:462–6.
Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, et al. Spontaneous breathing improves lung aeration in oleic acid-induced lung injury. 2003;99:376–84.
Munort BH, Jacobsen BS, DuffY ME, et al. Statistical methods for health care research 4th edition. University of Pennsilvania, Boston collage Lipincott U.S.A. 2002;1-412.
Rubenfeld GD, Caldwell E, Peabody E, et al: Incidence and outcomes of acute lung injury. N Engl J Med 2005; 353:1685–1693
Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med 2000; 342: 1334–1349
The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342:1301–1308
Kallet RH, Jasmer RM, Pittet JF, et al: Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls, Crit Care Med 2005; 33:925–929
Fan E, Needham DM, Stewart TE: Ventilatory management of acute lung injury and acute respiratory distress syndrome. JAMA 2005; 294:2889–2896
Roy SK, Emr B, Sadowitz B, Gatto LA, Ghosh A, Satalin JM, Snyder KP, Ge L, Wang G, Marx W, Dean D. Preemptive application of airway pressure release ventilation (APRV) prevents development of acute respiratory distress syndrome (ARDS) in a rat traumatic hemorrhagic shock model. Shock (Augusta, Ga.). 2013 Sep;40(3):210.
Maung AA, Kaplan LJ. Airway pressure release ventilation in acute respiratory distress syndrome. Critical care clinics. 2011 Jul 31;27(3):501-9.
Kollisch-Singule M, Emr B, Smith B, Roy S, Jain S, Satalin J, Snyder K, Andrews P, Habashi N, Bates J, Marx W, Nieman G, Gatto LA (2014) Mechanical breath profile of airway pressure release ventilation: the effect on alveolar recruitment and microstrain in acute lung injury. JAMA Surg 149:1138–1145
Kollisch-Singule M, Emr B, Smith B, Ruiz C, Roy S, Meng Q, Jain S, Satalin J, Snyder K, Ghosh A, Marx W, Andrews P, Habashi N, Nieman G, Gatto LA (2014) Airway pressure release ventilation reduces conducting airway micro-strain in lung injury. J Am Coll Surg 219:9
Kollisch-Singule M, Jain S, Andrews P, Smith BJ, Hamlington-Smith KL, Roy S, DiStefano D, Nuss E, Satalin J, Meng Q, Marx W, Bates JH, Gatto LA, Nieman GF, Habashi NM (2016) Effect of airway pressure release ventilation on dynamic alveolar heterogeneity. JAMA Surg 151(1):64–72.
Walkey AJ, Nair S, Papadopoulos S, Agarwal S, Reardon CC. Use of airway pressure release ventilation is associated with a reduced incidence of ventilator-associated pneumonia in patients with pulmonary contusion. Journal of Trauma and Acute Care Surgery. 2011 Mar 1;70(3):E42-7.
Kaplan LJ, Bailey H, Formosa V. Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome. Critical Care. 2001 Jul 2;5(4):221.
Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T, Mutz N. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. American journal of respiratory and critical care medicine. 2001 Jul 1;164(1):43-9.
Hering R, Peters D, Zinserling J, Wrigge H, von Spiegel T, Putensen C. Effects of spontaneous breathing during airway pressure release ventilation on renal perfusion and function in patients with acute lung injury. Intensive care medicine. 2002 Oct 1;28(10):1426-33.
Roy S, Habashi N, Sadowitz B, Andrews P, Ge L, Wang G, Roy P, Ghosh A, Kuhn M, Satalin J, Gatto LA. Early airway pressure release ventilation prevents ARDS-a novel preventive approach to lung injury. Shock (Augusta, Ga.). 2013 Jan;39(1):28.
Andrews PL, Shiber JR, Jaruga-Killeen E, Roy S, Sadowitz B, O’Toole RV, Gatto LA, Nieman GF, Scalea T, Habashi NM. Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature. Journal of Trauma and Acute Care Surgery. 2013 Oct 1;75(4):635-41.
Modrykamien A, Chatburn RL, Ashton RW. Airway pressure release ventilation: An alternative mode of mechanical ventilation in acute respiratory distress syndrome. Cleve Clin J Med. 2011 Feb 1;78(2):101-10.
Neumann, P., Golisch, W., Strohmeyer, A., Buscher, H., Burchardi, H., Sydow, M., 2002; Influence of different release times on spontaneous breathing pattern during airway pressure release ventilation. Intensive Care Med 28:1742–1749.