Jolene Lim1, Edward Litton2, Hayley Robinson3, Mike Das Gupta4. 1. Medical student, Royal Perth Hospital, Perth, Western Australia. 2. Staff Specialist Intensive Care Medicine, Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia; Clinical Senior Lecturer, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia. Electronic address: Ed_litton@hotmail.com. 3. Senior Registrar Intensive Care Medicine, Intensive Care Unit, Royal Perth Hospital, Western Australia. 4. Senior Clinical Respiratory Technician, Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia.
Abstract
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.
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.
Authors: Penny Andrews; Joseph Shiber; Maria Madden; Gary F Nieman; Luigi Camporota; Nader M Habashi Journal: Front Physiol Date: 2022-07-25 Impact factor: 4.755