Effect of Airway Pressure Release Ventilation Among Adult Patients With ARDS: Systematic Review and Meta-Analysis.

Abstract

Background:

ARDS is a severe condition that necessitates immediate medical intervention. Airway pressure release ventilation mode (APRV) has been an increasingly accepted means of supporting ARDS patients. However, recent data from randomized clinical trials (RCTs) regarding the effectiveness of using APRV among patients with ARDS is still conflicting. The purpose of this study, therefore, was to determine whether APRV mode is more effective in improving oxygenation and reducing hospital mortality compared to conventional ventilation (CV) among ARDS adult patients.

Methods:

We conducted this study following PRISMA guidelines. We searched for RCTs in PubMed, Embase, Web of Science, and the Cochrane library until April 2019. We considered for inclusion all studies that compared APRV and other CV modes among adult ARDS patients. Our primary outcomes were oxygenation status (defined as PaO₂/FIO₂ ratio) and hospital mortality. Risk of bias was assessed independently using appropriate tools.

Results:

In the initial search, we identified 118 potentially eligible studies in which 6 RCTs studies met our inclusion criteria with total of 375 patients. In all studies the effect of using APRV on oxygenation and mortality was assessed. PaO₂/FIO₂ ratio was similar between patients treated with ARPV and CV, mean difference = 0.62 mm Hg, (95%CI 0.05-1.3,I2=86%,P = 0.07). Mortality was lower among patients who received ARPV than patients who treated with CV (risk difference -0.05 days(95%CI -.13-0.03 days, P=0.02).

Conclusions:

In this study, using APRV mode was associated with reducing mortality among ARDS patients, without any improvement in oxygenation status. However, there is still a need for well-planned RCT to address the issue of improving oxygenation and safety of using APRV in clinical practice.