Airway pressure release ventilation.
TL;DR: This review will cover the definition and mechanism of airway pressure release ventilation, its advantages, indications, and guidance.
Abstract: Airway pressure release ventilation was introduced to clinical practice about two decades ago as an alternative mode for mechanical ventilation; however, it had not gained popularity until recently as an effective safe alternative for difficult-to-oxygenate patients with acute lung injury/ acute respiratory distress syndrome This review will cover the definition and mechanism of airway pressure release ventilation, its advantages, indications, and guidance
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TL;DR: Airway pressure release ventilation may offer potential clinical advantages for ventilator management of acute lung injury/acute respiratory distress syndrome and may be considered as an alternative “open lung approach” to mechanical ventilation.
Abstract: Objective:To review the use of airway pressure release ventilation (APRV) in the treatment of acute lung injury/acute respiratory distress syndrome.Data Source:Published animal studies, human studies, and review articles of APRV.Data Summary:APRV has been successfully used in neonatal, pediatric, an
296 citations
Cites background from "Airway pressure release ventilation..."
...APRV has been associated with a 70% reduction in NMBA requirements and a 30% to 40% reduction in sedation requirements when compared with conventional ventilation (3, 4, 11, 12, 23, 25, 110)....
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...Additional studies document reduction in sedation and NMBAs with APRV, and some, but not all (10), studies suggest less ventilator days and shorter length of intensive care unit stay (3, 4, 11, 12, 23, 25, 111)....
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TL;DR: Progress in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation, particularly as related to carbon monoxide and cyanide.
Abstract: Lung injury resulting from inhalation of smoke or chemical products of combustion continues to be associated with significant morbidity and mortality. Combined with cutaneous burns, inhalation injury increases fluid resuscitation requirements, incidence of pulmonary complications and overall mortality of thermal injury. While many products and techniques have been developed to manage cutaneous thermal trauma, relatively few diagnosis-specific therapeutic options have been identified for patients with inhalation injury. Several factors explain slower progress for improvement in management of patients with inhalation injury. Inhalation injury is a more complex clinical problem. Burned cutaneous tissue may be excised and replaced with skin grafts. Injured pulmonary tissue must be protected from secondary injury due to resuscitation, mechanical ventilation and infection while host repair mechanisms receive appropriate support. Many of the consequences of smoke inhalation result from an inflammatory response involving mediators whose number and role remain incompletely understood despite improved tools for processing of clinical material. Improvements in mortality from inhalation injury are mostly due to widespread improvements in critical care rather than focused interventions for smoke inhalation. Morbidity associated with inhalation injury is produced by heat exposure and inhaled toxins. Management of toxin exposure in smoke inhalation remains controversial, particularly as related to carbon monoxide and cyanide. Hyperbaric oxygen treatment has been evaluated in multiple trials to manage neurologic sequelae of carbon monoxide exposure. Unfortunately, data to date do not support application of hyperbaric oxygen in this population outside the context of clinical trials. Cyanide is another toxin produced by combustion of natural or synthetic materials. A number of antidote strategies have been evaluated to address tissue hypoxia associated with cyanide exposure. Data from European centers supports application of specific antidotes for cyanide toxicity. Consistent international support for this therapy is lacking. Even diagnostic criteria are not consistently applied though bronchoscopy is one diagnostic and therapeutic tool. Medical strategies under investigation for specific treatment of smoke inhalation include beta-agonists, pulmonary blood flow modifiers, anticoagulants and antiinflammatory strategies. Until the value of these and other approaches is confirmed, however, the clinical approach to inhalation injury is supportive.
203 citations
TL;DR: The beneficial effects of spontaneous breathing on intrapulmonary shunt and oxygenation are explained both by increased ventilation of aerated dependent lung tissue and by opening up nonaerated tissue so that ventilation is distributed to a larger share of the lung.
Abstract: Objective:In acute respiratory failure, gas exchange improves with spontaneous breathing during airway pressure release ventilation (APRV). The mechanisms for this improvement are not fully clear. We have shown that APRV with spontaneous breathing reopens nonaerated lung tissue in dorsal juxtadiaphr
146 citations
Cites background from "Airway pressure release ventilation..."
...During APRV, mechanical ventilatory support is achieved by periodic changes between two airway pressures while patients may breathe spontaneously at any time of the ventilatory cycle (7, 8)....
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TL;DR: Optimize positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.
Abstract: Objectives:We recently described how spontaneous effort during mechanical ventilation can cause “pendelluft,” that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (
144 citations
Cites background from "Airway pressure release ventilation..."
...Spontaneous breathing is traditionally encouraged in patients receiving mechanical ventilation (1, 2), and the putative advantages include improved gas exchange (1–4) and lessened propensity to deconditioning of the respiratory muscles, especially the diaphragm (5)....
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TL;DR: ICU ventilators of the future will be able to integrate electronically with other bedside technology; they will be unable to effectively ventilate all patients in all settings, invasively and noninvasively; ventilator management protocols will be incorporated into the basic operation of the ventilATOR.
Abstract: The use of ventilatory assistance can be traced back to biblical times. However, mechanical ventilators, in the form of negative-pressure ventilation, first appeared in the early 1800s. Positive-pressure devices started to become available around 1900 and today9s typical intensive care unit (ICU) ventilator did not begin to be developed until the 1940s. From the original 1940s ventilators until today, 4 distinct generations of ICU ventilators have existed, each with features different from that of the previous generation. All of the advancements in ICU ventilator design over these generations provide the basis for speculation on the future. ICU ventilators of the future will be able to integrate electronically with other bedside technology; they will be able to effectively ventilate all patients in all settings, invasively and noninvasively; ventilator management protocols will be incorporated into the basic operation of the ventilator; organized information will be presented instead of rows of unrelated data; alarm systems will be smart; closed-loop control will be present on most aspects of ventilatory support; and decision support will be available. The key term that will be used to identify these future ventilators will be smart!
129 citations