![]() Protocol development and review publication were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines ( 16). We present the following article in accordance with the PRISMA reporting checklist (available at ). The aim of our systematic review and meta-analysis was to confirm whether patients with ARDS have better primary outcomes (death during hospitalization and the number of ventilator-free days by day 28) when ventilated using APRV compared with LTVV. However, there are still some controversies in recent research for the two different ventilation modes. ![]() Many prospective randomized controlled trials (RCTs) and retrospective clinical trials have evaluated the feasibility, safety, and efficacy of APRV and LTVV for patients with ARDS. However, the benefits of APRV over conventional ventilation need to be confirmed. found that APRV could improve oxygenation and respiratory system compliance, decrease plateau pressure (P plat) and reduce the duration of both mechanical ventilation and intensive care unit (ICU) stay in patients with ARDS, as compared with LTVV ( 15). Potential advantages of APRV in ARDS include reduction in atelectrauma through decreased cyclical recruitment and de-recruitment, increased recruitment of lung units due to an increase in functional residual capacity, unrestricted spontaneous breathing, which improves ventilation/perfusion (V/Q) matching, and decreased sedation and neuromuscular blockade requirements ( 11- 14). ![]() Patients are able to maintain spontaneous breathing during ventilation with biphasic positive airway pressure (BIPAP) ventilation via a special time switching mode ( 10). The approach involves long duration (T high) high airway pressure (P high) and short duration (T low) low airway pressure (P low). The technique is a pressure-limited, time-cycled mode of ventilation, based on continuous positive airway pressure (CPAP) ( 9). Airway pressure release ventilation (APRV) was first conceptualized by Stock and Downs in 1987 ( 8). Severe ARDS, even when treated with a LTVV strategy, can result in high airway pressure and a poor prognosis. The prognosis of ARDS is closely related to mechanical ventilation airway pressure ( 7). Low tidal volume ventilation (LTVV), optimum positive end-expiratory pressure, permissive hypercapnia, lung recruitment, and the prone position are common treatments for ARDS ( 3- 6). Despite great improvements in mechanical ventilation in recent years, the mortality rate of ARDS is still high (40%) ( 2). Accepted for publication Nov 25, 2020.Īcute respiratory distress syndrome (ARDS) is an extremely dangerous lung condition that leads to low blood oxygen levels, and is commonly caused by sepsis, pneumonia, aspiration, and trauma ( 1). Keywords: Acute respiratory distress syndrome (ARDS) acute lung injury airway pressure release ventilation (APRV) low tidal volume ventilation (LTVV) We found APRV to be a safe and effective ventilation mode for patients with ARDS. There was no statistical difference in the incidence of pneumothorax (170 patients OR, 0.40 95% CI, 0.12–1.34 P=0.14).Ĭonclusions: The meta-analysis showed that APRV could reduce hospital mortality, duration of ventilation and ICU stay, improve lung compliance, oxygenation index, and MAP compared with LTVV for patients with ARDS. The results revealed that APRV was associated with lower hospital mortality, a shorter time of ventilator therapy, and intensive care unit (ICU) stay (315 patients MD, −4.50 95% CI, −6.56 to −2.44 P<0.0001), better respiratory system compliance on day 3 (202 patients MD, 8.19 95% CI, 0.84–15.54 P=0.03), arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) on day 3 (294 patients MD, 44.40 95% CI, 16.05–72.76 P=0.002), and higher mean arterial pressure (MAP) on day 3 (285 patients MD, 4.18 95% CI, 3.10–5.25 P<0.00001). Results: A total of 7 RCTs with a 405 patients were eligible for our meta-analysis. Methods: Randomized controlled trials (RCTs) comparing outcomes in ARDS ventilator therapy with APRV or LTVV were identified using Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, the Cochrane Library, and The Chinese Biomedicine Literature Database (SinoMed) from inception to March 2019. ![]() The purpose of this meta-analysis was to compare APRV and LTVV on patients with ARDS. Policy of Dealing with Allegations of Research Misconductīackground: It is uncertain whether airway pressure release ventilation (APRV) is better than low tidal volume ventilation (LTVV) for patients with acute respiratory distress syndrome (ARDS).Policy of Screening for Plagiarism Process. ![]()
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