Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome

Autor: V V Pettilä, O. Takkunen, R Niemi, Päivi Valta, Tero Varpula, Markku Hynynen
Rok vydání: 2004
Předmět:
Adult
Male
Mean arterial pressure
ARDS
Time Factors
medicine.medical_treatment
Blood Pressure
Statistics
Nonparametric
Intermittent Positive-Pressure Ventilation
Airway pressure release ventilation
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Continuous positive airway pressure
Cardiac Output
Propofol
Mechanical ventilation
Respiratory Distress Syndrome
Continuous Positive Airway Pressure
Dose-Response Relationship
Drug
Respiratory distress
Pulmonary Gas Exchange
business.industry
Hemodynamics
030208 emergency & critical care medicine
General Medicine
Hydrogen-Ion Concentration
Middle Aged
medicine.disease
3. Good health
Fentanyl
Oxygen
Treatment Outcome
Anesthesiology and Pain Medicine
030228 respiratory system
Anesthesia
Respiratory Mechanics
Breathing
Female
business
Anesthetics
Intravenous
Respiratory minute volume
Zdroj: Acta Anaesthesiologica Scandinavica. 48:722-731
ISSN: 1399-6576
0001-5172
DOI: 10.1111/j.0001-5172.2004.00411.x
Popis: Background: Airway pressure release ventilation (APRV) is a ventilatory mode, which allows unsupported spontaneous breathing at any phase of the ventilatory cycle. Airway pressure release ventilation as compared with pressure support (PS), another partial ventilatory mode, has been shown to improve gas exchange and cardiac output. We hypothesized whether the use of APRV with maintained unsupported spontaneous breathing as an initial mode of ventilatory support promotes faster recovery from respiratory failure in patients with acute respiratory distress syndrome (ARDS) than PS combined with synchronized intermittent ventilation (SIMV-group). Methods: In a randomized trial 58 patients were randomized to receive either APRVor SIMV after a predefined stabilization period. Both groups shared common physiological targets, and uniform principles of general care were followed. Results: Inspiratory pressure was significantly lower in the APRV-group (25.9 � 0.6 vs. 28.6 � 0.7 cmH2O) within the first week of the study (P ¼0.007). PEEP-levels and physiological variables (PaO2/FiO2-ratio, PaCO2, pH, minute ventilation, mean arterial pressure, cardiac output) were comparable between the groups. At day 28, the number of ventilator-free days was similar (13.4 � 1.7 in the APRV-group and 12.2 � 1.5 in the SIMV-group), as was the mortality (17% and 18%, respectively). Conclusion: We conclude that when used as a primary ventilatory mode in patients with ARDS, APRV did not differ from SIMV with PS in clinically relevant outcome.
Databáze: OpenAIRE
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