Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.022
Brazilian Journal of Anesthesiology
Original Investigation

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

O efeito da liberação preemptiva da pressão das vias aéreas na ventilação em pacientes com alto risco de síndrome do desconforto respiratório agudo: um ensaio clínico randomizado

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

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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

Resumo

Justificativa e objetivos: O objetivo deste estudo foi investigar o uso do modo APRV precoce como estratégia de proteção pulmonar em comparação aos métodos convencionais no que diz respeito ao desenvolvimento de SDRA. 

Métodos: O estudo foi desenhado como um ensaio de superioridade randomizado, não cego, centralizado, com dois grupos paralelos e um desfecho primário de desenvolvimento de SDRA. Pacientes sob ventilação mecânica invasiva que não foram diagnosticados com SDRA e tiveram pontuação de predição de lesão pulmonar maior que 7 foram incluídos no estudo. Os pacientes foram atribuídos aos grupos modo APRV e P-SIMV + PS. 
 
Resultados: Os pacientes foram tratados com P-SIMV + PS ou modo APRV; 33 (50,8%) e 32 (49,2%), respectivamente. Os valores da relação P / F foram maiores no grupo APRV no dia 3 (p = 0,032). O valor da fração inspirada de oxigênio foi menor no grupo APRV no dia 7 (p = 0,011). Enquanto 5 dos 33 pacientes (15,2%) no grupo P-SIMV + PS desenvolveram SDRA, um dos 32 pacientes (3,1 %) no grupo APRV desenvolveu SDRA durante o acompanhamento (p = 0,197). Os grupos não diferiram em termos de necessidade de vasopressor / inotrópico, taxas de extubação bem-sucedida e / ou taxas de mortalidade (p = 1,000, p = 0,911, p = 0,705,respectivamente). A duração da permanência na unidade de terapia intensiva foi de 8 (2-11) dias no grupo APRV e 13 (8-81) dias no grupo P-SIMV + PS (p = 0,019).

Palavras-chave

Síndrome respiratória aguda grave, Modo de ventilação APRV, Pressão positiva contínua de dois níveis nas vias aéreas, Unidade de Tratamento Intensivo, Modos de ventilação  

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Submitted date:
03/08/2020

Accepted date:
03/19/2021

60982c92a95395671704f173 rba Articles

Braz J Anesthesiol

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