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- Title
CLINICAL MANAGEMENT STRATEGIES FOR AIRWAY-PRESSURE RELEASE VENTILATION: A SURVEY OF CLINICAL PRACTICE.
- Authors
Miller, Andrew G.; Gentile, Michael A.; Davies, John D.; MacIntyre, Neil R.
- Abstract
Background: Airway-pressure release ventilation (APRV) is a widely used mode of ventilation designed to increase mPaw (and thus oxygenation) through prolonged inflation times and unrestricted spontaneous breathing. Different strategies for clinical management have been described in the literature; however, consensus on ventilator settings and clinical management strategies is lacking. The purpose of this study was to determine how APRV is currently managed by surveying practicing respiratory therapists. Methods: A 15 item survey was developed by the authors, posted on the AARConnect online media platform in January 2016 after approval from our institution's IRB. Survey questions were derived from a literature review of available information regarding APRV. Responses were limited to one per institution. Results: The survey was completed by 68 respondents, 88% of whom used APRV. No differences in hospital size, number of adult ICU beds, or the proportion of trauma centers for those who use APRV were reported. The most common intervention for patients failing conventional mechanical ventilation (CMV) was APRV (74% of respondents), followed by prone positioning (14%), pulmonary vasodilators (8%), HFOV (3%), and ECMO (2%). Initial APRV settings varied considerably amongst the respondents (table 1). The targeted release phase tidal volume was > 8 ml/kg for 44%, 6-8 ml/kg for 38% and 4 to 6 ml/kg for 19%. The maximum allowed P-high was ≥ 35 cmH2O for 81% of respondents. When oxygenation was below target, the next change in order of response frequency was: increase P-high, increase FiO2, increase T-high/decrease t-low, and increase P-low. When pH was below target the next change in order of response frequency was: increase P-high, increase RR/decrease t-high, increase t-low/decrease t-high, adjust sedation to increase spontaneous breathing, and add pressure support. Conclusion: There was no consensus for initial APRV settings or changes for suboptimal gas exchange. Many centers appear to be exposing patients to potentially harmful ventilator settings.
- Subjects
AIRWAY (Anatomy); ARTIFICIAL respiration; RESPIRATORY measurements; RESPIRATORY therapists; PROFESSIONAL practice
- Publication
Respiratory Care, 2016, Vol 61, Issue 10, pOF10
- ISSN
0020-1324
- Publication type
Article