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Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 13-21

Airway pressure release ventilation in comparison to synchronized intermittent mandatory ventilation in acute respiratory failure: a randomized controlled trial

1 Department of Pediatrics, Zagazig University, Zagazig, Egypt
2 Department of Internal Medicine, Zagazig University, Zagazig, Egypt
3 Department of Anesthesia, Zagazig University, Zagazig, Egypt
4 Department of Chest Diseases, Zagazig University, Zagazig, Egypt

Correspondence Address:
MD, PhD Dalia A Abdel Rahman
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, 11865
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AJOP.AJOP_10_20

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Background The main goal of mechanical ventilation is to support the respiratory drive safely and optimally. The authors are always transitioning through modes of mechanical ventilation either traditional or novel modes, trying to find out the optimum for each ventilation purpose. Recently, airway pressure release ventilation (APRV) has been digging through causes of respiratory failure, as a promising and challenging mode with interesting achievements throughout the clinical trials and case reports. Specially in critically ill patients with severe respiratory failure by means of offering a protective lung strategy throughout, recruiting it safely with better outcomes. Thoroughly, the authors aimed from this study to explore the hidden potentials of APRV mode as a safe recruiting mode could improve the gas exchange by increasing the surface area and maintain the opened alveoli for a while to get rid of inflammatory edema in comparison to the default ventilation mode in any type of respiratory failure. Patients and methods Single-blinded, randomized, controlled trial, which included 152 pediatric patients (56 men and 96 women) in an age range of 8 months to 17 years, who were admitted to the intensive care units either in Pediatrics, Chest Diseases, Anesthesia, or Internal Medicine Departments, Zagazig University Hospitals, Egypt, with acute respiratory failure. Of the patients, 76 were assigned to APRV mode and the other 76 patients were assigned to synchronized intermittent mandatory ventilation mode during a period from April 2017 to Jun 2019. Follow-up of arterial blood gases, ventilatory parameters, and vital signs were recorded. Primary and secondary outcomes including duration of ventilation, weaning outcome, and rate of mortality were documented. Results No significant difference was found between the APRV group and the synchronized intermittent mandatory ventilation group regarding mortality, complications, and weaning outcome. However, there was significant difference between outcomes of the challenging cases labeled acute respiratory distress syndrome and pulmonary edema connected to APRV. Conclusion The APRV mode showed superiority in supporting acute respiratory distress syndrome and pulmonary edema patients, with no higher risk of mortality or complications.

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