Other approaches to open-lung ventilation: airway pressure release ventilation.
OBJECTIVE
To review the use of airway pressure release ventilation (APRV) in the treatment of acute lung injury/acute respiratory distress syndrome.


METHODS
Published animal studies, human studies, and review articles of APRV.


METHODS
APRV has been successfully used in neonatal, pediatric, and adult forms of respiratory failure. Experimental and clinical use of APRV has been shown to facilitate spontaneous breathing and is associated with decreased peak airway pressures and improved oxygenation/ventilation when compared with conventional ventilation. Additionally, improvements in hemodynamic parameters, splanchnic perfusion, and reduced sedation/neuromuscular blocker requirements have been reported.


CONCLUSIONS
APRV may offer potential clinical advantages for ventilator management of acute lung injury/acute respiratory distress syndrome and may be considered as an alternative "open lung approach" to mechanical ventilation. Whether APRV reduces mortality or increases ventilator-free days compared with a conventional volume-cycled "lung protective" strategy will require future randomized, controlled trials.
Habashi
Nader M
NM
Multi-trauma ICU, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
D000818:Animals; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy