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Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies
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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003159/ https://www.ncbi.nlm.nih.gov/pubmed/32076372 http://dx.doi.org/10.1177/1179548420903297 |
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author | Fredericks, Andrew S Bunker, Matthew P Gliga, Louise A Ebeling, Callie G Ringqvist, Jenny RB Heravi, Hooman Manley, James Valladares, Jason Romito, Bryan T |
author_facet | Fredericks, Andrew S Bunker, Matthew P Gliga, Louise A Ebeling, Callie G Ringqvist, Jenny RB Heravi, Hooman Manley, James Valladares, Jason Romito, Bryan T |
author_sort | Fredericks, Andrew S |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7003159 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-70031592020-02-19 Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies Fredericks, Andrew S Bunker, Matthew P Gliga, Louise A Ebeling, Callie G Ringqvist, Jenny RB Heravi, Hooman Manley, James Valladares, Jason Romito, Bryan T Clin Med Insights Circ Respir Pulm Med Review 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. SAGE Publications 2020-02-05 /pmc/articles/PMC7003159/ /pubmed/32076372 http://dx.doi.org/10.1177/1179548420903297 Text en © The Author(s) 2020 https://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Fredericks, Andrew S Bunker, Matthew P Gliga, Louise A Ebeling, Callie G Ringqvist, Jenny RB Heravi, Hooman Manley, James Valladares, Jason Romito, Bryan T Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title | Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title_full | Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title_fullStr | Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title_full_unstemmed | Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title_short | Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies |
title_sort | airway pressure release ventilation: a review of the evidence, theoretical benefits, and alternative titration strategies |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003159/ https://www.ncbi.nlm.nih.gov/pubmed/32076372 http://dx.doi.org/10.1177/1179548420903297 |
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