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Airway Pressure Release Ventilation Does Not Protect Against Acute Respiratory Distress Syndrome Development in Surgical Critical Care Patients

Zachary M. Bauman, DO, MHA, Marika Y. Gassner, DO, Megan A. Coughlin, MD, Meredith Mahan, MS, Jill Watras, MD, FACS

Abstract


Background:
Acute respiratory distress syndrome(ARDS) is a challenging disease process with high mortality. Airway pressure release ventilation(APRV) has been shown to potentially protect against development of ARDS.
Methods:
Observational study of all ventilated patients admitted to the surgical intensive care unit(SICU) at a single, tertiary center. Patients were assigned to APRV or conventional ventilation(CV). ARDS was defined using the Berlin definition. Primary outcomes included development of ARDS between ventilation modalities, ability of APRV to protect against ARDS in septic patients and ability of APRV to decrease mortality. Univariate and multivariate logistic regression models were utilized. Statistical significance was defined as p<0.05.
Results:
268 total patients enrolled. 141(52.6%) developed ARDS. 119(44.4%) patients were on APRV and 149(55.6%) were on CV. ARDS development was not statistically different between these two cohorts(p=0.732). 108(40.3%) patients were septic with 49(45.4%) on APRV and 59(54.6%) on CV. 33(67.3%) of APRV and 37(62.7%) of CV septic patients developed ARDS suggesting APRV is not protective against development of ARDS in this cohort(p=0.616). APRV use did not protect against 30-day mortality with rates of 53.5% versus 46.5% for patients on APRV versus CV respectively(p=0.191).
Conclusion:
APRV does not appear to be protective against development of ARDS, even in septic patients. APRV is not superior to CV in decreasing mortality

Keywords


Airway Pressure Release Ventilation, Acute Respiratory Distress Syndrome, Lung Protective Strategies, Ventilator Management, Sepsis

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References


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