Describe the physiological rationale for airway pressure release ventilation (APRV). State the risks, benefits, indications for and potential contraindications to APRV. Outline the evidence supporting the use of APRV. Explain how to initiate, titrate, troubleshoot and wean a patient from APRV.

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BackgroundThe novel coronavirus SARS-CoV-2 and associated multisystem disease COVID-19 originated in Wuhan, China in December 2019. The resultant pandemic has resulted in an unprecedented strain on healthcare services around the world, including the greatest challenge seen by critical care medicine in modern times. This narrative illustrates the response of Nottingham University Hospitals NHS Trust critical care department to the crisis, including resource allocation and clinical management strategies and illustrates patient outcome for those admitted to critical care during the first pandemic wave.MethodsPatients admitted to critical care whom tested positive for SARS-CoV-2 between March-May 2020 were identified for retrospective case review as part of service evaluation. Clinical, laboratory and radiological data was collected. This included patient level data on ventilation and fluid balance.ResultsDuring the three period March-May 2020, retrospective case review showed 109 patients admitted to critical care with COVID-19. 88 (80.7%) of the 109 patients received mechanical ventilation, 21 (19.3%) patients received renal replacement therapy. Critical care mortality was 26 (23.9%) patients and hospital mortality was 27 (24.8%) of the 109 patients.ConclusionThis mortality rate was an unexpected finding based on early literature and help to provide a baseline for comparison hereafter. Commentary is provided for several aspects of care that may account for the low mortality rate and warrant further investigation in the future.