Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury

Facchin, Francesca; Fan, Eddy

doi:10.4187/respcare.04255

Cited by 32 publications

(38 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High-frequency oscillatory ventilation delivers very small tidal volumes, to prevent volutrauma, at a constant (relatively high) mean airway pressure. Despite their theoretical benefits, the clinical evidence of both techniques remains unproven and controversial for ARDS patients [ 16 ].…”

Section: Ventilatory Setting I: Tidal Volume/respiratory Ratementioning

confidence: 99%

The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

et al. 2016

View full text Add to dashboard Cite

Purpose: Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. Methods and results:A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO 2 /FIO 2 < 100. For mechanical ventilation specific settings are recommended: limitation of tidal volume (6 ml/ kg predicted body weight), adequate high PEEP (>12 cmH 2 O), a recruitment manoeuvre in special situations, and a 'balanced' respiratory rate (20-30/min). Individual bedside methods to guide PEEP/recruitment (e.g., transpulmonary pressure) are not (yet) available. Prone positioning [early (≤ 48 hrs after onset of severe ARDS) and prolonged (repetition of 16-hr-sessions)] improves survival. An advanced infection management/control includes early diagnosis of bacterial, atypical, viral and fungal specimen (blood culture, bronchoalveolar lavage), and of infection sources by CT scan, followed by administration of broad-spectrum anti-infectives. Neuromuscular blockage (Cisatracurium ≤ 48 hrs after onset of ARDS), as well as an adequate sedation strategy (score guided) is an important supportive therapy. A negative fluid balance is associated with improved lung function and the use of hemofiltration might be indicated for specific indications. Conclusions:A specific standard of care is required for the management of severe ARDS with refractory hypoxemia.

show abstract

Section: Ventilatory Setting I: Tidal Volume/respiratory Ratementioning

confidence: 99%

The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

et al. 2016

View full text Add to dashboard Cite

show abstract

“…On the other hand, the persistent airway pressure delivered by HFOV prevents lung collapse. 5 , 6 Some studies have demonstrated that HFOV could improve hypercapnia and oxygenation in children with ARDS and may be safely used. 7 , 8 Recently, the Pediatric Acute Lung Injury Consensus Conference recommends the use of HFOV in pediatric patients with severe ARDS as a rescue therapy when conventional ventilation fails.…”

Section: Introductionmentioning

confidence: 99%

High-frequency oscillatory ventilation is an effective treatment for severe pediatric acute respiratory distress syndrome with refractory hypoxemia

Guo

Wang

et al. 2016

TCRM

View full text Add to dashboard Cite

Background and purposeEarly or primary application of high-frequency oscillatory ventilation (HFOV) has been recently suggested not to offer benefit to patients with acute respiratory distress syndrome (ARDS). However, the rescue effects of HFOV on severe pediatric acute respiratory distress syndrome (PARDS) with hypoxemia refractory to conventional mechanical ventilation (CMV) remain unclear. This study aimed to determine whether severe PARDS children would benefit from HFOV when oxygenation deteriorated on CMV and to identify any potential risk factors related to mortality.Patients and methodsIn a retrospective and observational study, 48 children with severe PARDS between January 2009 and July 2015 were divided into two groups: 26 in HFOV group and 22 in CMV group. Data regarding demographic, underlying conditions, arterial blood gases and clinical outcomes were collected and analyzed.ResultsThe arterial partial pressure of oxygen (PaO2)/fraction of inspiration oxygen (FiO2) ratio and PaO2 improved significantly during HFOV, whereas arterial partial pressure of carbon dioxide (PaCO2) and oxygenation index decreased. There was no statistical difference in the in-hospital mortality between the groups (P=0.367). The odds ratio of survival in HFOV group was 2.74 (95% confidence interval 0.52 to 14.58, P=0.237). The pediatric intensive care unit length of stay and total ventilation duration were longer in HFOV group (P=0.048 and P=0.000, respectively). Vasoactive agents were used more frequently in HFOV group (P=0.007). The incidence of new air leak was similar between the two groups (P=0.674). The presence of multiple organ dysfunction syndrome and heavier body weight were identified as predictors of mortality in the HFOV group (P=0.006 and P=0.020, respectively).ConclusionHFOV as an efficient alternative therapy could significantly improve hypoxemia and promote CO2 removal in severe PARDS children when oxygenation progressively worsens on CMV.

show abstract

“…After two landmark APRV studies were published [14,15], scores of variable studies have followed, eventually establishing APRV as a means of protective lung strategy as well as a recommended early treatment for ALI or ARDS [12,16]. More recently, it has been suggested that early implementation of APRV is ideal [17,18]. There remains, however, a lack of specific recommendation on how best to apply this protective ventilation strategy [19].…”

Section: Aprvmentioning

confidence: 99%

An Investigation of Various Inspiratory Times and Inflation Pressures during Airway Pressure Release Ventilation

W¹,

E²,

C³

et al. 2019

Int J Respir Pulm Med

View full text Add to dashboard Cite

An Evaluation of Various Inspiratory Times and Inflation Pressures During Airway Pressure Release Ventilation. Introduction: There are few recommendations how best to apply certain modes of mechanical ventilation, and the application of Airway Pressure Release Ventilation (APRV) requires strategic implementation of specific inspiratory (I-time) and expiratory times (E-time) and particular mean airway pressures (MAWP), neither of which is standardized. We sought to identify whether an ideal I-time or MAWP could be identified to favor more positive clinical outcomes. Methods: A retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for a target of at least 8 hours. 68 adult subjects were evaluated from a convenient sample. Results: All outcomes of interest (surrogates) for shortterm clinical outcomes to include the PaO 2 /FiO 2 (P/F) ratio, Oxygen Index (OI), Oxygen Saturation Index (OSI), and Modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after at least approximately 8 hours on APRV. Most notably, there was significant improvement in P/F ratio (p = 0.012) and OSI (p = 0.000). Results of regression analysis showed MAWP as a significant positive predictor of post-APRV OSI and P high as a significant positive predictor of post-APRV MSOFA score. Conclusion: In summary, it was found that settings for P high, Plow, and T low in addition to overall MAWP and Body Mass Index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured with a lower setting for both P high and MAWP predictive of a better post-APRV OSI and MSOFA score.

show abstract

Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation: Potential Strategies to Treat Severe Hypoxemia and Prevent Ventilator-Induced Lung Injury

Cited by 32 publications

References 70 publications

The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

High-frequency oscillatory ventilation is an effective treatment for severe pediatric acute respiratory distress syndrome with refractory hypoxemia

An Investigation of Various Inspiratory Times and Inflation Pressures during Airway Pressure Release Ventilation

Contact Info

Product

Resources

About