- Pulmonary
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Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
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John S. Zorbas, Kwok M. Ho, Edward Litton, Bradley Wibrow, Edward Fysh, Matthew H. Anstey
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Acute Crit Care. 2021;36(2):143-150. Published online May 4, 2021
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DOI: https://doi.org/10.4266/acc.2021.00017
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 Abstract
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- 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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Citations
Citations to this article as recorded by  - Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome—A Multicenter Propensity Score–Matched Analysis
Jan-Hendrik Naendrup, Jonathan Steinke, Jorge Garcia Borrega, Sandra Emily Stoll, Per Ole Michelsen, Yannick Assion, Alexander Shimabukuro-Vornhagen, Dennis Alexander Eichenauer, Matthias Kochanek, Boris Böll
Journal of Intensive Care Medicine.2024; 39(1): 84. CrossRef - Acute Respiratory Failure From Early Pandemic COVID-19
Julia M. Fisher, Vignesh Subbian, Patrick Essay, Sarah Pungitore, Edward J. Bedrick, Jarrod M. Mosier
CHEST Critical Care.2024; 2(1): 100030. CrossRef - Airway Pressure Release Ventilation for Acute Respiratory Failure Due to Coronavirus Disease 2019: A Systematic Review and Meta-Analysis
Ashraf Roshdy, Ahmad Samy Elsayed, Ahmad Sabry Saleh
Journal of Intensive Care Medicine.2023; 38(2): 160. CrossRef - Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019
Guy A. Richards, Oliver Smith
Seminars in Respiratory and Critical Care Medicine.2023; 44(01): 091. CrossRef - Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?
Jiangli Cheng, Aijia Ma, Meiling Dong, Yongfang Zhou, Bo Wang, Yang Xue, Peng Wang, Jing Yang, Yan Kang
Journal of Intensive Medicine.2022; 2(4): 241. CrossRef - Early spontaneous breathing for acute respiratory distress syndrome in individuals with COVID-19
Friedrich Hohmann, Lisa Wedekind, Felicitas Grundeis, Steffen Dickel, Johannes Frank, Martin Golinski, Mirko Griesel, Clemens Grimm, Cindy Herchenhahn, Andre Kramer, Maria-Inti Metzendorf, Onnen Moerer, Nancy Olbrich, Volker Thieme, Astrid Vieler, Falk Fi
Cochrane Database of Systematic Reviews.2022;[Epub] CrossRef - Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis
Mallikarjuna Ponnapa Reddy, Ashwin Subramaniam, Clara Chua, Ryan Ruiyang Ling, Christopher Anstey, Kollengode Ramanathan, Arthur S Slutsky, Kiran Shekar
The Lancet Respiratory Medicine.2022; 10(12): 1178. CrossRef - Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef
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