The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial

Küçük, Mehtap Pehlivanlar; Erman Öztürk, Çağatay; Köylü İlkaya, Nazan; Küçük, Ahmet Oğuzhan; Ergül, Dursun Fırat; Ülger, Fatma

doi:10.1016/j.bjane.2021.03.022

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Brazilian Journal of Anesthesiology

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ORIGINAL INVESTIGATION • para Braz. J. Anesthesiol. 72 (01) • Jan-Feb 2022 • https://doi.org/10.1016/j.bjane.2021.03.022 copy

The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial^☆ ☆ The study was performed in a general intensive care unit with 18 bed capacity in Samsun Ondokuz Mayıs University, Hospital of School of Medicine, Intensive Care Unit, Samsun, Turkey.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

The objective of this study was to investigate the use of early APRV mode as a lung protective strategy compared to conventional methods with regard to ARDS development.

Methods:

The study was designed as a randomized, non-blinded, single-center, superiority trial with two parallel groups and a primary endpoint of ARDS development. Patients under invasive mechanical ventilation who were not diagnosed with ARDS and had Lung Injury Prediction Score greater than 7 were included in the study. The patients were assigned to APRV and P-SIMV + PS mode groups.

Results:

Patients were treated with P-SIMV+PS or APRV mode; 33 (50.8%) and 32 (49.2%), respectively. The P/F ratio values were higher in the APRV group on day 3 (p = 0.032). The fraction of inspired oxygen value was lower in the APRV group at day 7 (p = 0.011).While 5 of the 33 patients (15.2%) in the P-SIMV+PS group developed ARDS, one out of the 32 patients (3.1%) in the APRV group developed ARDS during follow-up (p = 0.197). The groups didn’t differ in terms of vasopressor/inotrope requirement, successful extubation rates, and/or mortality rates (p = 1.000, p = 0.911, p = 0.705, respectively). Duration of intensive care unit stay was 8 (2-11) days in the APRV group and 13 (8-81) days in the P-SIMV+PS group (p = 0.019).

Conclusions:

The APRV mode can be used safely in selected groups of surgical and medical patients while preserving spontaneous respiration to a make benefit of its lung-protective effects. In comparison to the conventional mode, it is associated with improved oxygenation, higher mean airway pressures, and shorter intensive care unit stay. However, it does not reduce the sedation requirement, ARDS development, or mortality.

KEYWORDS
Acute respiratory distress syndrome; APRV ventilation mode; Bi-level continuous positive airway pressure; intensive care unit; Ventilation modes

Parameter		P-SIMV+PS	APRV	p
Demographic Sex^a a Pearson chi-square test, p < 0.05.	Female	4 (33.33)	8 (66.67)
	Male	29 (54.72)	24 (45.28)	0.309
BMI^a a Pearson chi-square test, p < 0.05.	< 30	29 (54.72)	24 (45.28)
	> 30	4 (33.33)	8 (66.67)	0.309
Diagnosis Surgical/Trauma ^a a Pearson chi-square test, p < 0.05.
	Intracranial	13 (61.9)	8 (38.1)
	Intra-abdominal	2 (66.67)	1 (33.33)
	Orthopedic	1 (20)	4 (80)
	Thoracic	6 (50)	6 (50)
	Spinal Cord	0 (0)	2 (100)
Surgical/Non-trauma ^a a Pearson chi-square test, p < 0.05.	Other	3 (60)	2 (40)
	Intra-abdominal	5 (62.5)	3 (37.5)
Medical ^a a Pearson chi-square test, p < 0.05.	Other	1 (100)	0 (0)
	Pulmonary	1 (25)	3 (75)
	Intra-abdominal	0 (0)	1 (100)
	Other	1 (33.33)	2 (66.67)	0.500
Sepsis^a a Pearson chi-square test, p < 0.05.	No	31 (54.39)	26 (45.61)
	Yes	2 (25)	6 (75)	0.149
Comorbidity Comorbidity^a a Pearson chi-square test, p < 0.05.	No	19 (47.5)	21 (52.5)
	Yes	14 (56.0)	11 (44.0)	0.680

	P-SIMV+PS	APRV	p
Age (year)^a a Mann Whitney U test, p < 0.05.	54 (18-81)	50 (18-74)	0.590
Weight (kg)^a a Mann Whitney U test, p < 0.05.	82 (60-110)	80 (23-120)	0.402
LIPS^a a Mann Whitney U test, p < 0.05.	9 (7-13)	8.5 (7-12)	0.226
APACHE II^a a Mann Whitney U test, p < 0.05.	17 (7-36)	17 (7-35)	0.509
SOFA^a a Mann Whitney U test, p < 0.05.	6 (3-19)	7 (3-18)	0.464

Parameter	P-SIMV+PS	APRV	p
Sedation	30 (91.0)	23 (71.9)	0.061
Vasopressor/Inotrope^a a Pearson chi-square test, p < 0.05.	23 (69.7)	23 (71.9)	1.000
ARDS^a a Pearson chi-square test, p < 0.05.	5 (15.2)	1 (3.1)	0.197
Tracheotomy^a a Pearson chi-square test, p < 0.05.	5 (15.2)	2 (6.3)	0.427
Extubation^a a Pearson chi-square test, p < 0.05.	19 (57.6)	17 (53.1)	0.911
Mortality^a a Pearson chi-square test, p < 0.05.	17 (51.5)	14 (43.8)	0.705

	P-SIMV+PS	APRV	p
Weight (kg)^a a Mann Whitney U test, p < 0.05.	83.5 (60-95)	82.5 (34-120)	0.646
LIPS^a a Mann Whitney U test, p < 0.05.	9 (7-11)	8.5 (7-12)	0.443
APACHE II^a a Mann Whitney U test, p < 0.05.	16 (7-24)	17 (7-35)	0.164
SOFA^a a Mann Whitney U test, p < 0.05.	4.5 (3-10)	6.5 (3-17)	0.050
Sedation (total/day)^a a Mann Whitney U test, p < 0.05.	6.5 (2-65)	3 (1-18)	0.170
Vasopressor/Inotrope (total/day)^a a Mann Whitney U test, p < 0.05.	2 (1-15)	6.5 (1-14)	0.093
MV/Extubation duration (total/day)^a a Mann Whitney U test, p < 0.05.	10 (3-65)	8 (2-26)	0.211
ICU stay (day)^a a Mann Whitney U test, p < 0.05.	23.5 (10-81)	11 (2-58)	0.027
Hospital stay (day)^a a Mann Whitney U test, p < 0.05.	33 (17-85)	25.5 (8-79)	0.297

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] ☆
The study was performed in a general intensive care unit with 18 bed capacity in Samsun Ondokuz Mayıs University, Hospital of School of Medicine, Intensive Care Unit, Samsun, Turkey.