Omar, A., Taha, A., Elmetwally, T., Sivadasan, P., Khalil, M. (2021). Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.. test, 1(1), 1-14. doi: 10.21608/jicem.2021.231265
Amr Omar; Adel Taha; Tamer Elmetwally; Praveen Sivadasan; Mohamed Abdelhamid Khalil. "Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.". test, 1, 1, 2021, 1-14. doi: 10.21608/jicem.2021.231265
Omar, A., Taha, A., Elmetwally, T., Sivadasan, P., Khalil, M. (2021). 'Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.', test, 1(1), pp. 1-14. doi: 10.21608/jicem.2021.231265
Omar, A., Taha, A., Elmetwally, T., Sivadasan, P., Khalil, M. Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.. test, 2021; 1(1): 1-14. doi: 10.21608/jicem.2021.231265

Early transition to airway pressure release ventilation may facilitate weaning and improve the outcome of acute respiratory distress syndrome patients.

The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 1, Issue 1, December 2021, Pages 1-14    PDF (365.38 K)
Document Type: Original papers
DOI: 10.21608/jicem.2021.231265
Authors
Amr Omar* 1; Adel Taha2; Tamer Elmetwally3; Praveen Sivadasan4; Mohamed Abdelhamid Khalil5
1critical care department,faculty of medicine ,Beni-Suef University
2Consultant Intensivist, Critical Care Department, Saqr Hospital, EHS, UAE
3Associate Professor Anesthesia and Intensive Care, Mansoura University Hospital, Egypt
43) Consultant intensivist, heart hospital Hamad medical corporation, Doha, Qatar
5Professor of Anesthesia, Cairo university, Egypt. From the Department of critical care medicine/ Saqr Hospital, EHS, United Arab Emirates
Abstract
Background: High mortality is associated with acute respiratory distress syndrome (ARDS).
Methods: The study was a retrospective observational study on 39 patients with moderate to severe ARDS admitted between July 2010 and January 2013. Criteria for transition to Airway Pressure Release Ventilation (APRV) included

failure to wean down FiO2 below 60% after 24 hours,
hemodynamic instability due to high positive end-expiratory pressure (PEEP), and
failure to maintain plateau airway pressure below 30 cm H2O.

We compared the outcome of mandatory ventilation (CMV) and APRV groups with particular concern to the duration of mechanical ventilation, the requirement for tracheostomy, the requirement for vasopressors, and survival to ICU discharge.
Results: Twenty-four males and 15 females were included in the study with a mean age of 42 years (±24). Fourteen out of them fulfilled the criteria and were shifted to APRV within 24 hours of initiating mechanical ventilation. Ten out of 14 (70%) patients in the APRV arm survived ICU discharge versus 16 out of 25 (64%) patients in the CMV group (p 0.45). Survivors in the APRV group spent significantly shorter periods on mechanical ventilation than survivors in the CMV group (9.6 vs 12.1 days, p 0.03). Furthermore, APRV patients required significantly fewer tracheostomies and less vasopressor.
Conclusions: 
We concluded that APRV could be effectively used as a rescue mode of ventilation in patients with severe ARDS. Although our study does not show any mortality benefit of using APRV over CMV, there were shorter ventilation days and ICU stay days using APRV.
Keywords
APRV; CMV; ARDS
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