Characteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study

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• 作者：Jolene Lim ; MBBS (Hon)^a ; ¹ ; Edward Litton ; MB ; ChB ; MSs ; FCICM^b ; ^c ; ^{Ed_litton@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Hayley Robinson ; BMedSci (Hon) ; MBBS (Hon)^d ; Mike Das Gupta^e ; ²
• 关键词：Airway pressure release ventilation ; acute respiratory distress syndrome ; mechanical ventilation ; ECMO
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：34
• 期：Complete
• 页码：154-159
• 全文大小：555 K

文摘

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 99 mmHg (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.