Safety,Efficacy,and Clinical Outcomes of APRV in ARDS: A Systematic Review and Meta-Analysis

Abstract

Introduction

Airway pressure release ventilation (APRV) has been proposed as an alternative mode of mechanical ventilation for patients with acute respiratory distress syndrome (ARDS), aiming to enhance oxygenation while minimizing ventilator-induced lung injury. However, its comparative efficacy and safety relative to conventional ventilation strategies remain unclear. As such, this systematic review and meta-analysis was conducted to evaluate clinical and physiological outcomes associated with APRV in ARDS patients.

Methods

Following PRISMA guidelines, a comprehensive literature search was conducted across online databases through June 2025. Eligible studies included investigations comparing APRV with conventional ventilation modes in adult ARDS patients. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random-effects models.

Results

Nine studies encompassing 1921 patients met inclusion criteria. APRV was found to significantly improve oxygenation early in treatment, reflected by higher PaO₂/FiO₂ ratios on Days 1 and 3, and was associated with shorter ICU length of stay and more ventilator-free days compared with conventional ventilation. Plateau pressures were also notably reduced at Days 3 and 7, suggesting a lung-protective effect. However, no significant differences were observed in ICU or hospital mortality, total ventilator duration, or overall hospital length of stay.

Conclusion

These findings imply that APRV is able to enhance early oxygenation and improve ICU-related outcomes in ARDS without increasing mortality risk. While its physiologic advantages and potential lung-protective characteristics support its use as a viable alternative ventilation strategy, further large-scale trials are needed to confirm these findings and define optimal implementation protocols.