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Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study

BACKGROUND: Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to...

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Autores principales: Zorbas, John S., Ho, Kwok M., Litton, Edward, Wibrow, Bradley, Fysh, Edward, Anstey, Matthew H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Critical Care Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182154/
https://www.ncbi.nlm.nih.gov/pubmed/33940775
http://dx.doi.org/10.4266/acc.2021.00017
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author Zorbas, John S.
Ho, Kwok M.
Litton, Edward
Wibrow, Bradley
Fysh, Edward
Anstey, Matthew H.
author_facet Zorbas, John S.
Ho, Kwok M.
Litton, Edward
Wibrow, Bradley
Fysh, Edward
Anstey, Matthew H.
author_sort Zorbas, John S.
collection PubMed
description BACKGROUND: Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation. METHODS: A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated. RESULTS: Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03–0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation. CONCLUSIONS: Based on the findings of this study, we urge caution with the use of APRV in COVID-19.
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spelling pubmed-81821542021-06-15 Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study Zorbas, John S. Ho, Kwok M. Litton, Edward Wibrow, Bradley Fysh, Edward Anstey, Matthew H. Acute Crit Care Original Article BACKGROUND: Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation. METHODS: A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated. RESULTS: Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03–0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation. CONCLUSIONS: Based on the findings of this study, we urge caution with the use of APRV in COVID-19. Korean Society of Critical Care Medicine 2021-05 2021-05-04 /pmc/articles/PMC8182154/ /pubmed/33940775 http://dx.doi.org/10.4266/acc.2021.00017 Text en Copyright © 2021 The Korean Society of Critical Care Medicine https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Zorbas, John S.
Ho, Kwok M.
Litton, Edward
Wibrow, Bradley
Fysh, Edward
Anstey, Matthew H.
Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title_full Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title_fullStr Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title_full_unstemmed Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title_short Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
title_sort airway pressure release ventilation in mechanically ventilated patients with covid-19: a multicenter observational study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182154/
https://www.ncbi.nlm.nih.gov/pubmed/33940775
http://dx.doi.org/10.4266/acc.2021.00017
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