Now 22 years downstream from Stock and Downs' initial publication, we remain conflicted as to whether we should finally adopt APRV as a first-line mode for ventilating the acutely injured lung.
By dropping the higher pressure and stretching the period between release cycles, APRV can be used as one mode for all phases of ventilatory support, from the initial acute period right through the weaning phase into low level CPAP.
HFO and APRV have persuasive rationales to one or both of the two main investigational themes mentioned earlier.
For now, HFO and APRV still remain at the periphery of our practice.
The spontaneous breathing intrinsic to APRV will create diaphragmatic contractions that may enhance the recruitment of atelectatic alveoli in dependent regions of the lung field.
Recent investigations comparing APRV and conventional ventilation demonstrated a few interesting clinical outcomes.
During approximately 3 consecutive weeks of APRV and steroid therapy, the patient demonstrated gradual improvements in respiratory function, and a CT scan after extubation showed that the pulmonary infiltrates and ground-glass opacities had disappeared (Figure 3).
The case described here provides valuable findings that the use of APRV and high-dose corticosteroid therapy can contribute to the alleviation of respiratory distress in an SLE patient with severe DAH.
An expanded chapter on ventilation with newer modes (APRV
, ASV) described would be welcome--PAV is touched on.
Airway pressure release ventilation (APRV) can be effective in the re-expansion of the collapsed lung tissue, and it can maintain the maximum alveolar re-expansion in patients with ARDS.
After 24 hours of APRV application, significant improvements were observed in oxygenation and chest X-ray findings (Figure 3).
Unfortunately, many of the newer mode names give little or no clue to identify how it ventilates a patient (e.g.; APRV
, autoflow, Paug, etc.).