The Impact of Spontaneous Ventilation on Distribution of Lung Aeration in Patients with Acute Respiratory Distress Syndrome: Airway Pressure Release Ventilation Versus Pressure Support Ventilation
- 1 December 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 109 (6), 1892-1900
- https://doi.org/10.1213/ane.0b013e3181bbd918
Abstract
In this study, we sought to determine which mode, airway pressure release ventilation (APRV) or pressure support ventilation (PSV), decreases atelectasis more in patients with acute lung injury/acute respiratory distress syndrome (ARDS).This was a retrospective study in the intensive care unit. Between 2006 and 2007, we identified 18 patients with acute lung injury/ARDS who received either APRV or PSV and had a helical computed tomography scan twice in 3 days.Computed tomography data from the APRV and PSV groups (n = 9 each) were analyzed for 3-dimensional reconstruction and volumetry. Aerated lung regions (normally aerated, poorly aerated, nonaerated, and hyperinflated) were identified by their densities in Hounsfield units. The Pao(2)/Fio(2) ratio and alveolar-arteriolar oxygen gradient after ventilation were improved in both groups (P = 0.008); however, the improvements in the APRV group exceeded those in the PSV group when delivered with equal mean airway pressure (P = 0.018 and 0.015, respectively). Atelectasis decreased significantly from 41% (range, 17%-68%) to 19% (range, 6%-40%) (P = 0.008) and normally aerated volume increased significantly from 29% (range, 13%-41%) to 43% (range, 25%-56%) (P = 0.008) in the APRV group, whereas lung volume did not change in the PSV group.Spontaneous ventilation during APRV improves lung aeration by decreasing atelectasis. PSV for gas exchange is effective but not sufficient to improve lung aeration. These results indicate that APRV is more efficient than PSV as a mode of primary ventilatory support to decrease atelectasis in patients with ARDS.Keywords
This publication has 31 references indexed in Scilit:
- Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndromeActa Anaesthesiologica Scandinavica, 2004
- Spontaneous Breathing Improves Lung Aeration in Oleic Acid–induced Lung InjuryAnesthesiology, 2003
- Pressure Support Compared with Controlled Mechanical Ventilation in Experimental Lung InjuryAnesthesia & Analgesia, 2002
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeNew England Journal of Medicine, 2000
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996
- Effect of Interfacing between Spontaneous Breathing and Mechanical Cycles on the Ventilation-Perfusion Distribution in Canine Lung InjuryAnesthesiology, 1994
- Inspiratory work of breathing on flow-by and demand-flow continuous positive airway pressureCritical Care Medicine, 1989
- Respiratory Function during Pressure Support VentilationChest, 1986
- Prognosis in Acute Organ-System FailureAnnals of Surgery, 1985
- Effects of Anesthesia and Paralysis on Diaphragmatic Mechanics in ManAnesthesiology, 1974