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Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis.
Lutz, Mark R; Charlamb, Jacob; Kenna, Joshua R; Smith, Abigail; Glatt, Stephen J; Araos, Joaquin D; Andrews, Penny L; Habashi, Nader M; Nieman, Gary F; Ghosh, Auyon J.
Afiliación
  • Lutz MR; Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Charlamb J; Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Kenna JR; Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Smith A; Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Glatt SJ; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Araos JD; Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Andrews PL; Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
  • Habashi NM; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
  • Nieman GF; Department of Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA.
  • Ghosh AJ; Department of Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA.
J Clin Med ; 13(9)2024 May 03.
Article en En | MEDLINE | ID: mdl-38731219
ABSTRACT
Airway pressure release ventilation (APRV) is a protective mechanical ventilation mode for patients with acute respiratory distress syndrome (ARDS) that theoretically may reduce ventilator-induced lung injury (VILI) and ARDS-related mortality. However, there is no standard method to set and adjust the APRV mode shown to be optimal. Therefore, we performed a meta-regression analysis to evaluate how the four individual APRV settings impacted the outcome in these patients.

Methods:

Studies investigating the use of the APRV mode for ARDS patients were searched from electronic databases. We tested individual settings, including (1) high airway pressure (PHigh); (2) low airway pressure (PLow); (3) time at high airway pressure (THigh); and (4) time at low pressure (TLow) for association with PaO2/FiO2 ratio and ICU length of stay.

Results:

There was no significant difference in PaO2/FiO2 ratio between the groups in any of the four settings (PHigh difference -12.0 [95% CI -100.4, 86.4]; PLow difference 54.3 [95% CI -52.6, 161.1]; TLow difference -27.19 [95% CI -127.0, 72.6]; THigh difference -51.4 [95% CI -170.3, 67.5]). There was high heterogeneity across all parameters (PhHgh I2 = 99.46%, PLow I2 = 99.16%, TLow I2 = 99.31%, THigh I2 = 99.29%).

Conclusions:

None of the four individual APRV settings independently were associated with differences in outcome. A holistic approach, analyzing all settings in combination, may improve APRV efficacy since it is known that small differences in ventilator settings can significantly alter mortality. Future clinical trials should set and adjust APRV based on the best current scientific evidence available.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Clin Med Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Clin Med Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Suiza