APRV: Preventing Mechanical Ventilation Complications - Evita V800 Ventilation Scene

APRV: Preventing Mechanical Ventilation Complications

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Unrestricted spontaneous breathing with Airway Pressure Release Ventilation (APRV)

As Your Specialist in Acute Care, we understand that Airway Pressure Release Ventilation (PC-APRV) enables spontaneous breathing under continuous positive airway pressure with brief pressure releases. With PC-APRV you could maximize the benefits of spontaneous breathing and stabilize and maintain the end expiratory lung volume.

Proven facts: APRV stabilizes Alveoli and reduces strain and stress

  • APRV with spontaneous breathing increased oxygenation, cardiac index, and pulmonary compliance with reduced sedation requirements as compared with conventional positive pressure ventilation.1
  • Reduced alveolar and conducting airway microstrain as well as increased alveolar homogenity using a personalized APRV approach.2
  • APRV allows for personalized control of lung stability on a breath-to-breath basis that is not possible with other modes of ventilation.3

The idea of APRV

Mechanical ventilation can save lives but it can also cause negative side-effects, such as lung damage. APRV is based on the principle of the open lung approach, which can help by improving oxygenation, facilitating spontaneous breathing and protecting the lungs against complications by improving oxygenation.

Ventilation therapy and APRV

From treatment to prevention: APRV facilitates spontaneous breathing by delivering continuous positive airway pressure (CPAP) and augments ventilation with brief releases. Take a look at how this can prevent mechanical ventilation complications, such as ARDS.

How it works

It’s a pressure controlled ventilation mode where it’s possible to set two different levels of pressure (Phigh and Plow) and two different timings for the two pressure levels (Thigh and Tlow). In PC-APRV, the patient’s spontaneous breathing takes place at the upper pressure level Phigh. This pressure level Phigh is maintained for the duration of Thigh. The alternation between the two pressure levels is machine-triggered and time cycled. The breathing volume expired during the release times, results from the pressure difference between Phigh and Plow and the lung mechanics. Since resistance and/or compliance may change during the ventilation treatment, the supplied tidal volume and thus the minute volume also vary.

When the underlying pulmonary condition is restrictive and hypoxic in nature, fewer and shorter releases should be scheduled to avoid de-recruitment and maintain end-expiratory lung volume. When hypercapnia is an issue, more and longer releases will be required to assure sufficient ventilation.

The clinical use

APRV has been shown to facilitate spontaneous breathing and is associated with decreased peak airway pressures and improved oxygenation/ventilation when compared with conventional ventilation. Additionally, improvements in hemodynamic parameters, splanchnic perfusion, and reduced sedation/neuromuscular blocker requirements have been reported. APRV may offer potential clinical advantages for ventilator management of acute lung injury/acute respiratory distress syndrome and may be considered as an alternative “open lung approach” to mechanical ventilation.

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Clinical evidence on APRV shows that...

In patients suffering from moderate to severe ARDS, application of APRV improved lung function and hemodynamics. It also reduced the need for sedatives and the duration of mechanical ventilation as well as days in ICU.4

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References/ Sources

  1.   Putensen C., Zech S. et al. "Long-term effects of spontaneous breathing  during ventilatory support in patients with acute lung injury", American Journal of Critica Care Medicine 2001; 164; 43-49.
  2.  Kollish-Singule, M. Emr, B. et al. "APRV reduces conducing airway micro-strain in lung injury", Journal of American College of Surgeons 2014, 219.9.
  3.  Summeet et al. "The 30-year evolution of Airway Pressure Release Ventilation (APRV), Intensive Care Med Exp. 2016, 4:11. Published online 2016 May 20.
  4.  Li JQ. Et al. "Clinical research about airway pressure release ventilation for moderate to severe acute respiratory distress syndrome", Eur Rev Med Pharmacol Sci. 2016 Jun; 20(12):2634-41 

Ventilation therapy video gallery

APRV history, terminology and best practices

In this workshop from the Dräger Advanced Ventilation Symposium, Dr. Nadar Habashi covers the basics of APRV history, terminology, best practices, applications and benefits – including the impact of APRV on the incidence and mortality of ARDS, the concepts of APRV and the use of APRV in preventing ARDS.

APRV settings and clinical applications

Ms. Penny Andrews talks about APRV settings and clinical applications. Take a look at the video to take a deeper dive into the topic of APRV and ventilation therapy.

Suggested downloads

Get more information about APRV here in our download section:

APRV quick setup guide

Dräger quick setup guide for APRV

Dr. Luigi Camporota, from Guy’s and St Thomas’ NHS Foundation Trust lends his expert knowledge to our quick guide for APRV.

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APRV infographic
Did you know?

Take a look at this infographic to get a quick overview and understanding of APRV and how and when it can be applied in clinical settings.

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Ventilation modes in intensive care
Ventilation modes in intensive care

Our insight into how the understanding and clinical use of NIV has evolved over time.

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APRV booklet
Ventilation function sheet APRV

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Mechanical ventilation: As non-invasive as possible, as invasive as necessary. Patients in the intensive care unit (ICU), who are dependent on mechanical ventilation, need the best care from admission to discharge – and beyond.

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