title: Airway pressure release ventilation: what do we know?
abstract: Airway pressure release ventilation (APRV) is inverse ratio, pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing. It is based on the principle of open lung approach. It has many purported advantages over conventional ventilation, including  alveolar recruitment, improved oxygenation, preservation of spontaneous breathing, improved hemodynamics, and potential lung-protective effects. It has many claimed disadvantages related to risks of volutrauma, increased work of breathing, and increased energy expenditure related to spontaneous  breathing. APRV is used mainly as a rescue therapy for the difficult to oxygenate patients with acute respiratory distress syndrome (ARDS). There is confusion regarding this mode of ventilation, due to the different terminology used in the literature. APRV settings include the "P high,"  "T high," "P low," and "T low". Physicians and respiratory therapists should be aware of the different ways and the rationales for setting these variables on the ventilators. Also, they should be familiar with the differences between APRV, biphasic positive  airway pressure (BIPAP), and other conventional and nonconventional modes of ventilation. There is no solid proof that APRV improves mortality; however, there are ongoing studies that may reveal further information about this mode of ventilation. This paper reviews the different methods proposed  for APRV settings, and summarizes the different studies comparing APRV and BIPAP, and the potential benefits and pitfalls for APRV.
authors.affiliation: Respiratory Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ehab G
authors.initials: EG
authors.lastname: Daoud
authors.forename: Hany L
authors.initials: HL
authors.lastname: Farag
authors.forename: Robert L
authors.initials: RL
authors.lastname: Chatburn
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000295:instrumentation / Q000379:methods; D054810:Deep Sedation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D012119:Respiration; D012128:Respiratory Distress Syndrome / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D018570:Risk Assessment; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000592:standards
chemical_list: D010100:Oxygen