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Original Article
Pulmonary
Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study
John S. Zorbas, Kwok M. Ho, Edward Litton, Bradley Wibrow, Edward Fysh, Matthew H. Anstey
Acute Crit Care. 2021;36(2):143-150.   Published online May 4, 2021
DOI: https://doi.org/10.4266/acc.2021.00017
  • 9,763 View
  • 519 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDF
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.

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
Guideline
Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group
Korean J Crit Care Med. 2016;31(2):76-100.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.76
  • 16,727 View
  • 351 Download
  • 6 Crossref
AbstractAbstract PDF
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Citations

Citations to this article as recorded by  
  • Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
    Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
    Acute and Critical Care.2024; 39(1): 91.     CrossRef
  • Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
    Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
    Acute and Critical Care.2023; 38(1): 41.     CrossRef
  • Treatment of acute respiratory failure: invasive mechanical ventilation
    Young Sam Kim
    Journal of the Korean Medical Association.2022; 65(3): 151.     CrossRef
  • Treatment of acute respiratory failure: extracorporeal membrane oxygenation
    Jin-Young Kim, Sang-Bum Hong
    Journal of the Korean Medical Association.2022; 65(3): 157.     CrossRef
  • Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
    Rob Mac Sweeney, Daniel F McAuley
    The Lancet.2017; 389(10078): 1516.     CrossRef
  • Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness
    Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
    Frontiers in Pediatrics.2016;[Epub]     CrossRef

ACC : Acute and Critical Care