Log in | Register

Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study

Marco González| Alejandro C. Arroliga| Fernando Frutos-Vivar| Konstantinos Raymondos| Andres Esteban| Christian Putensen| Carlos Apezteguía| Javier Hurtado| Pablo Desmery| Vinko Tomicic| José Elizalde| Fekri Abroug| Yaseen Arabi| Rui Moreno| Antonio Anzueto| Niall D. Ferguson
Original
Volume 36, Issue 5 / May , 2010

Pages 817 - 827

Abstract

Purpose

To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality.

Methods

Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups.

Results

In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital.

Conclusions

In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation.

Keywords

References

  1. Stock MC, Downs JB, Frolicher DA (1987) Airway pressure release ventilation. Crit Care Med 15:462–466
    • View reference on publisher's website
    • View reference on PubMed
  2. Rose L, Hawkins M (2008) Airway pressure release ventilation and biphasic positive airway pressure: a systematic review of definitional criteria. Intensive Care Med 34:1766–1773
  3. Putensen C, Wrigge H (2004) Clinical review: biphasic positive airway pressure and airway pressure release ventilation. Crit Care 8:492–497
    • View reference on publisher's website
    • View reference on PubMed
  4. Varpula T, Valta P, Niemi R, Takkunen O, Hynynen M, Pettilä VV (2004) Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome. Acta Anesthesiol Scand 48:722–731
    • View reference on publisher's website
  5. Seymour CW, Frazer M, Reilly PM, Fuchs BD (2007) Airway pressure release and biphasic intermittent positive airway pressure ventilation: are they ready for prime time? J Trauma 62:1298–1308
    • View reference on publisher's website
    • View reference on PubMed
  6. Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, González M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D’Empaire G, Sandi F, Matamis D, Montañez AM, Anzueto A (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 177:170–177
    • View reference on publisher's website
    • View reference on PubMed
  7. Siau C, Stewart TE (2008) Current role of high frequency oscillatory ventilation and airway pressure release ventilation in acute lung injury and acute respiratory distress syndrome. Clin Chest Med 29:265–275
    • View reference on publisher's website
    • View reference on PubMed
  8. Putensen C, Zech S, Wrigge H, Zinserling J, Stüber F, Von Spiegel T, Mutz N (2001) Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 164:43–49
    • View reference on PubMed
  9. Dart BW IV, Maxwell RA, Richart CM, Brooks DK, Ciraulo DL, Barker DE, Burns RP (2005) Preliminary experience with airway pressure release ventilation in a trauma/surgical intensive care unit. J Trauma 59:71–76
    • View reference on publisher's website
    • View reference on PubMed
  10. Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation–perfusion distribution in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159:1241–1248
    • View reference on PubMed
  11. Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA (1994) Long term effects of two different ventilatory modes on oxygenation in acute lung injury: comparison of airway pressure release ventilation and volume-controlled inverse-ratio ventilation. Am J Respir Crit Care Med 149:1550–1556
    • View reference on PubMed
  12. Rathgeber J, Schorn B, Falk B, Kazmaier S, Spiegel T, Burchardi H (1997) The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives: a prospective analysis in 596 patients following adult cardiac surgery. Eur J Anesthesiol 14:576–582
    • View reference on publisher's website
  13. Weitzen S, Lapane KL, Toledano AY, Hume AL, Mor V (2004) Principles for modelling propensity scores in medical research: a systematic literature review. Pharmacoepidemiol Drug Saf 13:841–853
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement