Clinical usefulness of airway pressure release ventilation

Patients with acute respiratory failure in whom spontaneous ventilation is insufficient to maintain an adequate level of alveolar ventilation because of central or peripheral respiratory depression (i.e. neuromuscular abnormalities, flail chest, etc.) are good candidates for this technique ( Rouby 1994). In such situations airway pressure release ventilation can normalize alveolar ventilation without increasing peak airway pressure.

A cross-over design study in patients with acute lung injury (Sydow ,§L§L 1994) compared volume-controlled inverse ratio ventilation and airway pressure release ventilation on a long-term basis. After 24 h, an improvement in the ratio of P(A-a)o2 to Fio2 was observed during airway pressure release ventilation but not during volume-controlled inverse ratio ventilation. These results were attributed to progressive alveolar recruitment and the persistence of spontaneous inspiratory activity.

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