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.

Introduction: Dysphagia is defined as a sensation of difficulty in swallowing food through the oral cavity or
through the esophagus. It is classified as oropharyngeal or esophageal. Dysphagia appears more frequently
in elderly patients; as many as 30–40% of residents in nursing homes are reported to experience dysphagia
in some form and extent1. Dysphagia aortica is a type of esophageal dysphagia caused by the external
compression of esophagus by a tortuous or an aneurysmal aorta. Though it is a rare cause of dysphagia, it
should be in the differential always, as missing this diagnosis can be catastrophic. Women, elderly, short
stature, hypertension and kyphosis are believed to be predisposed to the same2.We report this case to draw
the clinicians‟ attention towards dysphagia as a possible initial presentation of aneurysm.