Abstract
Background:
There are few recommendations on how best to apply certain modes of mechanical ventilation, and the application of airway pressure release ventilation (APRV) in particular requires strategic implementation of specific inspiratory times (i-times) and particular mean airway pressures (Paw) neither of which is standardized. We sought to identify whether an ideal i-time or Paw could be identified to favor positive clinical outcomes.
Methods:
Institutional Review Board approval was obtained. A retrospective analysis of archived electronic health record data was assessed to evaluate the clinical outcomes of adult patients that had been placed on APRV for a target of at least 8 h. Sixty-eight adult subjects were evaluated as part of a convenient sample.
Results:
All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FIO2 (P/F) ratio, Oxygen Index (OI), oxygen saturation index (OSI), and modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after approximately 8 h on APRV. There was significant improvement in P/F ratio (P= .012) and OSI (P< .001). Results of regression analysis showed Paw as a significant positive predictor of post-APRV OSI and Phigh as a significant positive predictor of post-APRV MSOFA score.
Conclusions:
It was found that settings for Phigh, Plow, and Tlow in addition to overall Paw and body mass index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured and a lower setting for both Phigh and Paw was predictive of a better post-APRV OSI and MSOFA score.
Paired t-test performed View all access options for this article.Clinical Outcomes
Change Score: Pre-Post APRV
n (x, SD)
p-value
P/F ratio
18 (-44.28, 66.42)
.012
OI
18 (8.77, 20.44)
.086
OSI
63 (6.34, 9.50)
.000
MSOFA
52 (.096, 2.45)
.778
Get full access to this article