Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies
| Autor: | James L. Manley, Bryan T Romito, Matthew P. Bunker, Andrew S. Fredericks, Hooman Heravi, Jenny R.B. Ringqvist, Jason Valladares, Louise A. Gliga, Callie Gittemeier Ebeling |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
lcsh:RC705-779 lcsh:Diseases of the circulatory (Cardiovascular) system lung diffusion business.industry ventilation Respiratory disease respiratory failure 030208 emergency & critical care medicine Review lcsh:Diseases of the respiratory system medicine.disease respiratory disease Airway pressure release ventilation Clinical Practice 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Respiratory failure lcsh:RC666-701 Anesthesia Medicine Cardiology and Cardiovascular Medicine business Hypoxia |
| Zdroj: | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, Vol 14 (2020) Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine |
| ISSN: | 1179-5484 |
| Popis: | Objective:To review the theoretical benefits of airway pressure release ventilation (APRV), summarize the evidence for its use in clinical practice, and discuss different titration strategies.Data Source:Published randomized controlled trials in humans, observational human studies, animal studies, review articles, ventilator textbooks, and editorials.Data Summary:Airway pressure release ventilation optimizes alveolar recruitment, reduces airway pressures, allows for spontaneous breathing, and offers many hemodynamic benefits. Despite these physiologic advantages, there are inconsistent data to support the use of APRV over other modes of ventilation. There is considerable heterogeneity in the application of APRV among providers and a shortage of information describing initiation and titration strategies. To date, no direct comparison studies of APRV strategies have been performed. This review describes 2 common management approaches that bedside providers can use to optimally tailor APRV to their patients.Conclusion:Airway pressure release ventilation remains a form of mechanical ventilation primarily used for refractory hypoxemia. It offers unique physiological advantages over other ventilatory modes, and providers must be familiar with different titration methods. Given its inconsistent outcome data and heterogeneous use in practice, future trials should directly compare APRV strategies to determine the optimal management approach. |
| Databáze: | OpenAIRE |
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