The effect of APRV-LTV mechanical ventilation mode on SpO2 and ventilation indices in patients with COVID-19
Abstract
Background & Aim: Mechanical ventilation is a life-saving method for acute respiratory distress syndrome. The present study aimed to investigate the impact of airway pressure release ventilation-low tidal volume mode on COVID-19 patients’ peripheral capillary oxygen saturation and ventilation indices.
Methods & Materials: This clinical trial was conducted on 70 COVID-19 patients hospitalized in the Intensive care unit in Qom, Iran. Patients were selected using convenience sampling and randomly allocated to intervention and control groups. In the control group, patients were ventilated using synchronized intermittent mandatory ventilation mode and in the intervention group, patients were ventilated using airway pressure release ventilation-low tidal volume mode. Patients’ peripheral capillary oxygen saturation, and ventilation indices were checked and recorded before and after intervention. The data were analyzed using SPSS 11.5.
Results: According to the results of the repeated-measures ANOVA test, before the intervention and the 2 and 4 hours after the intervention, there were no significant differences between the intervention and control groups regarding the fraction of inspired oxygen, volume minute per minute, and peripheral capillary oxygen saturation (P>0.05). However, in the intervention group compared to the control group, the mean of PIP was significantly reduced (P<0.05).
Conclusion: In patients with COVID-19, the two modes of mechanical ventilation, APRV, and control, had no significant differences in the fraction of inspired oxygen, volume minute per minute, and peripheral capillary oxygen saturation. However, the mean peak inspiratory pressure reduction in the intervention group was greater than that in the control group. Considering that several factors can affect peripheral capillary oxygen saturation and ventilation indices, these results should be considered with caution.
2. Wiegand DL. AACN procedure manual for high acuity, progressive, and critical Care-E-Book: Elsevier Health Sciences; 2016.
3. Hussein ME, Osuji J. Brunner & Suddarth's Canadian Textbook of Medical-Surgical Nursing: Wolters Kluwer Health; 2019.
4. Shelledy DC, Peters JI. Mechanical Ventilation: Jones & Bartlett Learning; 2019.
5. Lazoff SA, Bird K. Synchronized Intermittent Mandatory Ventilation. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
6. Ali AAE-R, El Wahsh RAE-R, Agha MAE-S, Tawadroos BB. Pressure regulated volume-controlled ventilation versus synchronized intermittent mandatory ventilation in COPD patients suffering from acute respiratory failure. Egyptian Journal of Chest Diseases and Tuberculosis. 2016;65(1):121-5.
7. Cheng J, Ma A, Dong M, Zhou Y, Wang B, Xue Y, et al. Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome? Journal of Intensive Medicine. 2022;2(4):241-8.
8. Swindin J, Sampson C, Howatson A. Airway pressure release ventilation. BJA education. 2020;20(3):80-8.
9. Hirshberg EL, Lanspa MJ, Peterson J, Carpenter L, Wilson EL, Brown SM, et al. Randomized Feasibility Trial of a Low Tidal Volume-Airway Pressure Release Ventilation Protocol Compared With Traditional Airway Pressure Release Ventilation and Volume Control Ventilation Protocols. Critical care medicine. 2018;46(12):1943-52.
10. Fredericks AS, Bunker MP, Gliga LA, Ebeling CG, Ringqvist JR, Heravi H, et al. Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies. Clin Med Insights Circ Respir Pulm Med. 2020;14:1179548420903297.
11. Serpa Neto A, Deliberato RO, Johnson AEW, Bos LD, Amorim P, Pereira SM, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive care medicine. 2018;44(11):1914-22.
12. Gorman EA, O’Kane CM, McAuley DF. Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management. The Lancet. 2022;400(10358):1157-70.
13. Sarkar M, Niranjan N, Banyal PK. Mechanisms of hypoxemia. Lung India: official organ of Indian Chest Society. 2017;34(1):47-60.
14. Ahmadi A, Foroghi Ghomi SY, Lotfi S. Controlled Modes Can Be as Effective as CPAP and BiPAP in Non-invasive Ventilation in COVID-19. Anesthesiology and pain medicine. 2021;11(5):e120405.
15. Liu L, Tanigawa K, Ota K, Tamura T, Yamaga S, Kida Y, et al. Practical use of airway pressure release ventilation for severe ARDS--a preliminary report in comparison with a conventional ventilatory support. Hiroshima Journal of Medical Sciences. 2009;58(4):83-8.
16. González M, Arroliga AC, Frutos-Vivar F, Raymondos K, Esteban A, Putensen C, et al. Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study. Intensive Care Medicine. 2010;36(5):817-27.
17. Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, VON SPIEGEL T, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. American Journal of Respiratory and Critical Care Medicine. 2001;164(1):43-9.
18. Fan E, Khatri P, Mendez-Tellez PA, Shanholtz C, Needham DM. Review of a large clinical series: sedation and analgesia usage with airway pressure release and assist-control ventilation for acute lung injury. Journal of Intensive Care Medicine. 2008;23(6):376-83.
19. Pan C, Liu L, Xie JF, Qiu HB. Acute respiratory distress syndrome: challenge for diagnosis and therapy. Chinese Medical Journal. 2018 May 20;131(10):1220-4.
20. Jain SV, Kollisch-Singule M, Sadowitz B, Dombert L, Satalin J, Andrews P, et al. The 30-year evolution of airway pressure release ventilation (APRV). Intensive Care Medicine Experimental. 2016;4(1):11.
21. Nieman GF, Satalin J, Andrews P, Aiash H, Habashi NM, Gatto LA. Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI). Intensive care medicine experimental. 2017;5(1):8.
22. Ioannidis G, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, et al. Barotrauma and pneumothorax. Journal of Thoracic Disease. 2015;7(Suppl 1):S38-43.
23. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England Journal of Medicine. 2000;342(18):1301-8.
24. Mehaffey JH, Charles EJ, Sharma AK, Money DT, Zhao Y, Stoler MH, et al. Airway pressure release ventilation during ex vivo lung perfusion attenuates injury. The Journal of Thoracic and Cardiovascular Surgery. 2017;153(1):197-204.
25. Sun X, Liu Y, Li N, You D, Zhao Y. The safety and efficacy of airway pressure release ventilation in acute respiratory distress syndrome patients: A PRISMA-compliant systematic review and meta-analysis. Medicine. 2020;99(1):e18586.
26. Roy SK, Emr B, Sadowitz B, Gatto LA, Ghosh A, Satalin JM, et al. Preemptive application of airway pressure release ventilation prevents the development of acute respiratory distress syndrome in a rat traumatic hemorrhagic shock model. Shock (Augusta, Ga). 2013;40(3):210-6.
27. Zhou Y, Jin X, Lv Y, Wang P, Yang Y, Liang G, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Medicine. 2017;43(11):1648-59.
Files | ||
Issue | Vol 10 No 2 (2023): Spring | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/npt.v10i2.12831 | |
Keywords | ||
respiratory distress syndrome; COVID-19; artificial respiration; oxygen saturation; respiratory insufficiency |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |