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Airway pressure release ventilation

J Hunter Mehaffey, Eric J Charles, Ashish K Sharma, Dustin T Money, Yunge Zhao, Mark H Stoler, Christine L Lau, Curtis G Tribble, Victor E Laubach, Mark E Roeser, Irving L Kron
OBJECTIVE: Critical organ shortages have resulted in ex vivo lung perfusion gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of donation after circulatory death organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation during ex vivo lung perfusion improves lung function after transplantation. METHODS: Two groups (n = 4 animals/group) of porcine donation after circulatory death donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of ex vivo lung perfusion rehabilitation with standard conventional volume-based ventilation or pressure-based airway pressure release ventilation...
September 22, 2016: Journal of Thoracic and Cardiovascular Surgery
Jeffrey J Fletcher, Thomas J Wilson, Venkatakrishna Rajajee, Scott B Davidson, Jon C Walsh
PURPOSE: Airway pressure release ventilation (APRV) utilizes high levels of airway pressure coupled with brief expiratory release to facilitate open lung ventilation. The aim of our study was to evaluate the effects of APRV-induced elevated airway pressure mean in patients with severe traumatic brain injury. MATERIALS AND METHODS: This was a retrospective cohort study at a 424-bed Level I trauma center. Linear mixed effects models were developed to assess the difference in therapeutic intensity level (TIL), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) over time following the application of APRV...
September 20, 2016: Journal of Intensive Care Medicine
Vahid Siavashi, Simin Asadian, Masoud Taheri-Asl, Homa Babaei, Samaneh Keshavarz, Mohammad Bazaei, Seyed Mahdi Nassiri
Many infants who develop bronchopulmonary dysplasia (BPD) are born with serious respiratory distress syndrome (RDS), which is associated with impaired vascular and alveolar growth. RDS is a breathing disorder that mostly affects preterm infants and occurs in infants whose lungs have not yet been fully developed. The use of surfactant in RDS treatment does not necessarily prevent BPD. Endothelial progenitor cells (EPCs) may contribute to lung angiogenesis for the prevention and treatment of BPD. The aim of this study was to evaluate the therapeutic efficacy of phototherapy for EPC release in preterm infants born with RDS...
September 20, 2016: Journal of Cellular Biochemistry
Yoshihisa Morimoto, Takaki Sugimoto, Hiroki Arase, Fumiya Haba
INTRODUCTION: Postoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery. PRESENTATION OF CASE: A 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning...
2016: International Journal of Surgery Case Reports
Jia-Qiong Li, Hong-Yang Xu, Mao-Qin Li, Jing-Yu Chen
In the present study, the effect of setting high airway pressure release ventilation (APRV) pressure guided by an expiratory inflection point of pressure-volume (PV) curve following lung recruitment maneuver (RM) on oxygen delivery (DO2) in canine models of severe acute respiratory distress syndrome (ARDS) was examined. Canine models of severe ARDS were established by intravenous injection of oleic acid. After injection of sedative muscle relaxants, a PV curve plotted using the super-syringe technique, and the pressure at lower inflection point (LIP) at the inhale branch and the pressure at the point of maximum curvature (PMC) at the exhale branch were measured...
September 2016: Experimental and Therapeutic Medicine
Zheng Li, Quan Wang, Suyun Qian
No abstract text is available yet for this article.
January 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
J-Q Li, N Li, G-J Han, C-G Pan, Y-H Zhang, X-Z Shi, J-Y Xu, B Lu, M-Q Li
OBJECTIVE: To evaluate clinical effects of airway pressure release ventilation (APRV) in patients suffering from moderate to severe acute respiratory distress syndrome (ARDS).e of a patient presented with significant high aminotransferase levels due to the first human R. aeschlimannii infection ever detected in Italy. The hypothesis of rickettsiosis was made on the basis of a comprehensive medical history and was confirmed by serological tests. Molecular analyses made on a sample of hepatic tissue revealed the presence of a rickettsial species never found before in human liver...
June 2016: European Review for Medical and Pharmacological Sciences
Glen T Granati, Getu Teressa
BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure...
2016: American Journal of Case Reports
Eduardo Mireles-Cabodevila, Robert M Kacmarek
Airway pressure release ventilation (APRV) was originally described as a mode to treat lung-injured patients with the goal to maintain a level of airway pressure that would not depress the cardiac function, deliver mechanical breaths without excessive airway pressure, and to allow unrestricted spontaneous ventilation. Indeed, based on its design, APRV has technological features that serve the goals of safety and comfort. Animal studies suggest that APRV leads to alveolar stability and recruitment which result in less lung injury...
June 2016: Respiratory Care
Sumeet V Jain, Michaela Kollisch-Singule, Benjamin Sadowitz, Luke Dombert, Josh Satalin, Penny Andrews, Louis A Gatto, Gary F Nieman, Nader M Habashi
Airway pressure release ventilation (APRV) was first described in 1987 and defined as continuous positive airway pressure (CPAP) with a brief release while allowing the patient to spontaneously breathe throughout the respiratory cycle. The current understanding of the optimal strategy to minimize ventilator-induced lung injury is to "open the lung and keep it open". APRV should be ideal for this strategy with the prolonged CPAP duration recruiting the lung and the minimal release duration preventing lung collapse...
December 2016: Intensive Care Medicine Experimental
Rabe E Alhurani, Richard A Oeckler, Pablo Moreno Franco, Sarah M Jenkins, Ognjen Gajic, Sonal R Pannu
RATIONALE: The management of severe and refractory hypoxemia in critically ill adult patients is practice based. Variability across individual practitioners and institutions is not well documented. OBJECTIVES: To conduct a nationwide survey of critical care physicians in the United States regarding accepted definitions and management strategies for severe and refractory hypoxemia. METHODS: A web-based survey was distributed to a stratified random sample of adult intensivists listed in the American Medical Association Physician Masterfile...
July 2016: Annals of the American Thoracic Society
Jolene Lim, Edward Litton, Hayley Robinson, Mike Das Gupta
BACKGROUND: The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. The goal of this study was to describe the clinical and physiological effects of APRV in patients with established ARDS. METHODS: This retrospective observational study was performed in a 23-bed adult intensive care unit in a tertiary extracorporeal membrane oxygenation (ECMO) referral centre...
August 2016: Journal of Critical Care
Christopher J Montanaro
Patients with refractory intracranial hypertension often require short-term mechanical ventilation because they cannot protect their airway. Airway pressure release ventilation (APRV) is less commonly used than other modes because it is thought to increase intracranial pressure. However, this case study describes how APRV improved alveolar recruitment and functional residual capacity in a patient with refractory intracranial hypertension secondary to severe traumatic brain injury.
March 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
Benjamin Sadowitz, Sumeet Jain, Michaela Kollisch-Singule, Joshua Satalin, Penny Andrews, Nader Habashi, Louis A Gatto, Gary Nieman
Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients...
February 4, 2016: World Journal of Critical Care Medicine
Mary C Mushambi, Sahana Jaladi
PURPOSE OF REVIEW: Airway management and failed intubation in the pregnant woman requires unique considerations, which differ from the nonpregnant patient. Factors that influence airway management in this setting include anatomical and physiological changes in pregnancy, environmental factors as well as training matters. In addition, surgery is often being performed with extreme urgency, which requires rapid decision-making process that takes into account safe outcome of mother and baby...
June 2016: Current Opinion in Anaesthesiology
Shaohua Song, Huiyu Tian, Xiufen Yang, Zhenjie Hu
OBJECTIVE: To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. METHODS: A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled...
January 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Melvin Stone, Anna Liveris, Stanley Kalata, Shira Yellin, Carlos Vargas, Edward Chao, Srinivas Reddy, Sheldon Teperman
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
Neil G Parry, Bradley Moffat, Kelly Vogt
PURPOSE OF REVIEW: The treatment of blunt thoracic injuries is complex and evolving. The aim of this review is to focus on what is new with ventilation for blunt chest trauma as well as an update on the current management strategies for blunt aortic injury and rib fractures. RECENT FINDINGS: Early use of noninvasive ventilation appears to be well tolerated in select hemodynamically stable blunt trauma patients. For those patients requiring intubation, airway pressure release ventilation is an excellent mode to decrease the risk of posttraumatic acute lung injury...
December 2015: Current Opinion in Critical Care
Michaela Kollisch-Singule, Sumeet Jain, Penny Andrews, Bradford J Smith, Katharine L Hamlington-Smith, Shreyas Roy, David DiStefano, Emily Nuss, Josh Satalin, Qinghe Meng, William Marx, Jason H T Bates, Louis A Gatto, Gary F Nieman, Nader M Habashi
IMPORTANCE: Ventilator-induced lung injury may arise from heterogeneous lung microanatomy, whereby some alveoli remain collapsed throughout the breath cycle while their more compliant or surfactant-replete neighbors become overdistended, and this is called dynamic alveolar heterogeneity. OBJECTIVE: To determine how dynamic alveolar heterogeneity is influenced by 2 modes of mechanical ventilation: low tidal-volume ventilation (LTVV) and airway pressure release ventilation (APRV), using in vivo microscopy to directly measure alveolar size distributions...
January 2016: JAMA Surgery
Esmond L Arrindell, Ramesh Krishnan, Marie van der Merwe, Frank Caminita, Scott C Howard, Jie Zhang, Randal K Buddington
A translational preterm pig model analogous to infants born at 28 wk of gestation revealed that continuous positive airway pressure results in limited lung recruitment but does not prevent respiratory distress syndrome, whereas assist-control + volume guarantee (AC+VG) ventilation improves recruitment but can cause injury, highlighting the need for improved ventilation strategies. We determined whether airway pressure release ventilation (APRV) can be used to recruit the immature lungs of preterm pigs without injury...
November 15, 2015: American Journal of Physiology. Lung Cellular and Molecular Physiology
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