Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV).
ARDS动物模型表明，最新的气道压力释放通气(APRV)能够显著改善氧合，促进肺复张，减轻肺损伤，且不影响循环功能。因此，我们假设，与小潮气量肺保护性通气(LTV)相比，ARDS患者早期使用APRV可能加速肺功能恢复，缩短机械通气时间。
A total of 138 patients with ARDS who received mechanical ventilation for <48 h between="" may="" 2015="" to="" october="" 2016="" while="" in="" the="" critical="" care="" medicine="" unit="" (icu)="" of="" the="" west="" china="" hospital="" of="" sichuan="" university="" were="" enrolled="" in="" the="" study.="" patients="" were="" randomly="" assigned="" to="" receive="" aprv="" (n =" 71)" or="" ltv="" (n =" 67)." the="" settings="" for="" aprv="" were:="" high="" airway="" pressure="">high) set at the last plateau airway pressure (Pplat), not to exceed 30 cmH2O) and low airway pressure ( Plow) set at 5 cmH2O; the release phase (Tlow) setting adjusted to terminate the peak expiratory flow rate to ≥ 50%; release frequency of 10-14 cycles/min. The settings for LTV were: target tidal volume of 6 mL/kg of predicted body weight; Pplat not exceeding 30 cmH2O; positive end-expiratory pressure (PEEP) guided by the PEEP-FiO2 table according to the ARDSnet protocol. The primary outcome was the number of days without mechanical ventilation from enrollment to day 28. The secondary endpoints included oxygenation, Pplat, respiratory system compliance, and patient outcomes.
从2015年5月至2016年10月，四川大学华西医院ICU收治的138名接受机械通气不足48小时的ARDS患者入选此研究。患者被随机分为APRV组(n = 71)或LTV组(n = 67)。APRV设置如下：气道高压 (Phigh) 设置为最近的平台压 (Pplat) 水平，且不超过30 cmH2O，气道低压(Plow) 设置为5 cmH2O；压力释放时间 (Tlow) 设置为呼气末流量相当于呼气峰流量 ≥ 50%；释放频率 10-14 次/分。LTV的设置为：目标潮气量 6 mL/kg理想体重；Pplat 不超过 30 cmH2O；根据ARDSnet方案的PEEP-FiO2 表格设置PEEP。
Compared with the LTV group, patients in the APRV group had a higher median number of ventilator-free days {19 [interquartile range (IQR) 8-22] vs. 2 (IQR 0-15); P < 0.001}. this="" finding="" was="" independent="" of="" the="" coexisting="" differences="" in="" chronic="" disease.="" the="" aprv="" group="" had="" a="" shorter="" stay="" in="" the="" icu="" (p =" 0.003)." the="" icu="" mortality="" rate="" was="" 19.7%="" in="" the="" aprv="" group="" versus="" 34.3%="" in="" the="" ltv="" group="" (p =" 0.053)" and="" was="" associated="" with="" better="" oxygenation="" and="" respiratory="" system="" compliance,="" lower="">plat, and less sedation requirement during the first week following enrollment (P < 0.05, repeated-measures="" analysis="" of="">
与LTV组相比，APRV组患者无机械通气中位天数显著增加{19 [四分位区间 (IQR) 8-22] vs. 2 (IQR 0-15); P < 0.001}。这一结果与合并的慢性疾病无关。aprv组icu住院日缩短(p = 0.003)。aprv组患者icu病死率19.7%，ltv组为34.3% (p ="">plat 更低，需要镇静药物更少（P <>
Compared with LTV, early application of APRV in patients with ARDS improved oxygenation and respiratory system compliance, decreased Pplat and reduced the duration of both mechanical ventilation and ICU stay.
与LTV相比，ARDS患者早期使用APRV能够改善氧合及呼吸系统顺应性，降低Pplat，缩短机械通气时间及ICU住院日。
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