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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 10/2008

01.10.2008 | Review

Airway pressure release ventilation and biphasic positive airway pressure: a systematic review of definitional criteria

verfasst von: Louise Rose, Martyn Hawkins

Erschienen in: Intensive Care Medicine | Ausgabe 10/2008

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Abstract

Objective

The objective of this study was to identify the definitional criteria for the pressure-limited and time-cycled modes: airway pressure release ventilation (APRV) and biphasic positive airway pressure (BIPAP) available in the published literature.

Design

Systematic review.

Methods

Medline, PubMed, Cochrane, and CINAHL databases (1982–2006) were searched using the following terms: APRV, BIPAP, Bilevel and lung protective strategy, individually and in combination. Two independent reviewers determined the paper eligibility and abstracted data from 50 studies and 18 discussion articles.

Measurements and results

Of the 50 studies, 39 (78%) described APRV, and 11 (22%) described BIPAP. Various study designs, populations, or outcome measures were investigated. Compared to BIPAP, APRV was described more frequently as extreme inverse inspiratory:expiratory ratio [18/39 (46%) vs. 0/11 (0%), P = 0.004] and used rarely as a noninverse ratio [2/39 (5%) vs. 3/11 (27%), P = 0.06]. One (9%) BIPAP and eight (21%) APRV studies used mild inverse ratio (>1:1 to ≤2:1) (P = 0.7), plus there was increased use of 1:1 ratio [7 (64%) vs. 12 (31%), P = 0.08] with BIPAP. In adult studies, the mean reported set inspiratory pressure (PHigh) was 6 cm H2O greater with APRV when compared to reports of BIPAP (P = 0.3). For both modes, the mean reported positive end expiratory pressure (PLow) was 5.5 cm H2O. Thematic review identified inconsistency of mode descriptions.

Conclusions

Ambiguity exists in the criteria that distinguish APRV and BIPAP. Commercial ventilator branding may further add to confusion. Generic naming of modes and consistent definitional parameters may improve consistency of patient response for a given mode and assist with clinical implementation.
Literatur
1.
Hormann C, Baum M, Putensen C, Koller W, Putz G (1994) Biphasic positive airway pressure (BIPAP)—a new mode of ventilatory support. Eur J Anaesthesiol 11:37–42PubMed
2.
Kuhlen R, Rossaint R (2002) The role of spontaneous breathing during mechanical ventilation. Respir Care 47:296–303PubMed
3.
McCunn M, Habashi NM (2002) Airway pressure release ventilation in the acute respiratory distress syndrome following traumatic injury. Int Anaesthesiol Clin 40:89–102
4.
Habashi N (2005) Other approaches to open-lung ventilation: airway pressure release ventilation. Crit Care Med 33:S228–S240PubMedCrossRef
5.
Putensen C, Wrigge H (2006) Airway pressure-release ventilation. In: Tobin M (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York
6.
Hedenstierna G, Lattuada M (2002) Gas exchange in the ventilated patient. Curr Opin Crit Care 8:39–44PubMedCrossRef
7.
Sydow M (2001) Biphasic positive airway pressure (BIPAP) and airway pressure release ventilation (APRV). In: Kuhlen R, Guttman J, Rossaint R (eds) New forms of assisted spontaneous breathing. Urban & Fischer Verlag, Munich, pp 35–65
8.
Putensen C, Mutz N, Putensen-Himmer G, Zinserling J (1999) Spontaneous breathing during ventilatory support improves ventilation–perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 159:1241–1248PubMed
9.
Varpula T, Valta P, Niemi R, Takkunen O, Hynynen M, Pettila V (2004) Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome. Acta Anaesthesiol Scand 48:722–731PubMedCrossRef
10.
Neumann P, Schubert A, Heuer J, Hinz J, Quintel M, Klockgether-Radke A (2005) Hemodynamic effects of spontaneous breathing in the post-operative period. Acta Anaesthesiol Scand 49:1443–1448PubMedCrossRef
11.
Davis K, Johnson D, Branson R, Campbell R, Johannigman J, Porembka D (1993) Airway pressure release ventilation. Arch Surg 128:1348–1352PubMed
12.
Putensen C, Rasanen J, Lopez F (1995) Interfacing between spontaneous breathing and mechanical ventilation affects ventilation–perfusion distributions in experimental bronchoconstriction. Am J Respir Crit Care Med 151:993–999PubMed
13.
Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ (2000) How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 161:1450–1458PubMed
14.
Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein S, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 28:345–355CrossRef
15.
Minitab (2003) Minitab version 14. Minitab, USA
16.
Burns N, Grove S (2001) The practice of nursing research, 4th edn. W·B. Saunders, Philadelphia
17.
Bratzke E, Downs J, Smith R (1998) Intermittent CPAP: a new mode of ventilation during general anesthesia. Anesthesiology 89:334–340PubMedCrossRef
18.
Calzia E, Lindner KH, Witt S, Schirmer U, Lange H, Stenz R, Georgieff M (1994) Pressure–time product and work of breathing during biphasic continuous positive airway pressure and assisted spontaneous breathing. Am J Respir Crit Care Med 150:904–910PubMed
19.
Cane R, Peruzzi W, Shapiro B (1991) Airway pressure release ventilation in severe acute respiratory failure. Chest 100:460–463PubMedCrossRef
20.
Chiang A, Steinfeld A, Gropper C, MacIntyre NR (1994) Demand-flow airway pressure release ventilation as a partial ventilatory support mode: comparison with synchronized intermittent mandatory ventilation and pressure ventilation. Crit Care Med 22:1431–1437PubMedCrossRef
21.
Dart B, Maxwell R, Richart C, Brooks D, Ciraulo D, Barker D, Burns RP (2005) Preliminary experience with airway pressure release ventilation in a trauma/surgical intensive care unit. J Trauma 59:71–76PubMedCrossRef
22.
Elrazek E (2004) Randomized prospective crossover study of biphasic intermittent positive airway pressure ventilation (BIPAP) versus pressure support ventilation (PSV) in surgical intensive care patients. Middle East J Anaesthesiol 17:1009–1021
23.
Falkenhain S, Reilley T, Gregory J (1992) Improvement in cardiac output during airway pressure release ventilation. Crit Care Med 20:1358–1360PubMedCrossRef
24.
Florete O, Banner M, Banner T, Rodriguez J, Kirby R (1989) Airway pressure release ventilation in a patient with acute pulmonary injury. Chest 96:679–682PubMedCrossRef
25.
Foland J, Martin J, Novotny T, Super D, Dyer R, Mhanna M (2001) Airway pressure release ventilation with a short release time in a child with acute respiratory distress syndrome. Respir Care 46:1019–1023PubMed
26.
Frawley P, Cowan J (2002) Airway pressure release ventilation: the future of trauma ventilatory support? J Trauma Nurs 9:75–82
27.
Garner W, Downs J, Stock M, Rasanen J (1988) Airway pressure release ventilation: a human trial. Chest 94:779–781PubMedCrossRef
28.
Hormann C, Baum M, Putensen C, Kleinsasser A, Benzer H (1997) Effects of spontaneous breathing with BIPAP on pulmonary gas exchange in patients with ARDS. Acta Anaesthesiol Scand Suppl 111:152–155PubMed
29.
Kaplan L, Bailey H, Formosa V (2001) Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome. Crit Care 5:221–226PubMedCrossRef
30.
Kazmaier S, Rathgeber J, Buhre W, Biuscher H, Busch T, Mechsching K, Sonntag H (2000) Comparison of ventilatory and haemodynamic effects of BIPAP and S-IMV/PSV for postoperative short-term ventilation in patients after coronary artery bypass grafting. Eur J Anaesthesiol 17:601–610PubMedCrossRef
31.
Neumann P, Golisch W, Strohmeyer A, Buscher H, Burchardi H, Sydow M (2002) Influence of different release times on spontaneous breathing pattern during airway pressure release ventilation. Intensive Care Med 28:1742–1749PubMedCrossRef
32.
Putensen C, Zech S, Wrigge H, Zinserling J, Stuber 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 164:43–49PubMed
33.
Rasanen J, Cane R, Downs J, Hurst J, Jousela I, Kirby R, Rogove HJ, Stock MC (1991) Airway pressure release ventilation during acute lung injury: a prospective multicenter trial. Crit Care Med 19:1234–1241PubMed
34.
Rathgeber J, Schorn B, Falk V, Kazmaier S, Spiegel T, Burchardi H (1997) The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic 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 Anaesthesiol 14:576–582PubMedCrossRef
35.
Schultz TR, Durning SM (1999) Case report. Airway pressure release ventilation. RT: J Respir Care Prac 12:84–85
36.
Schultz TR, Costarino AT Jr, Durning SM, Napoli LA, Schears G, Godinez RI, Priestley M, Dominguez T, Lin R, Helfaer M (2001) Airway pressure release ventilation in pediatrics. Pediatr Crit Care Med 2:243–246PubMedCrossRef
37.
Staudinger T, Kordova H, Roggla M, Tesinsky P, Locke G, Laczik K, Knapp S, Frazz M (1998) Comparison of oxygen cost of breathing with pressure-support ventilation and biphasic intermittent positive airway pressure ventilation. Crit Care Med 26:1518–1522PubMedCrossRef
38.
Sydow M, Burchardi H, Ephraim E, Zielman S (1994) Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Am J Respir Crit Care Med 149:1550–1556PubMed
39.
Uyar M, Demirag K, Olgun E, Cankayali I, Moral A (2005) Comparison of oxygen cost of breathing between pressure-support and airway pressure release ventilation. Anaesthes Intensive Care 33:218–222
40.
Valentine D, Hammond M, Downs J, Sears N, Sims W (1991) Distribution of ventilation and perfusion with different modes of mechanical ventilation. Am Rev Respir Dis 143:1262–1266PubMed
41.
Varpula T, Pettila V, Nieminem H, Takkunen O (2001) Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome. Acta Anaesthesiol Scand 45:340–344PubMedCrossRef
42.
Varpula T, Jousela I, Niemi R, Takkunen O, Pettila V (2003) Combined effects of prone positioning and airway pressure release ventilation on gas exchange in patients with acute lung injury. Acta Anaesthesiol Scand 47:516–524PubMedCrossRef
43.
Wrigge H, Zinserling J, Hering R, Schwalferberg N, Stuber F, Von Spiegel T, Schroeder S, Hedenstierna G, Putensen C (2001) Cardiorespiratory effects of automatic tube compensation during airway pressure release ventilation in patients with acute lung injury. Anesthesiology 95:382–389PubMedCrossRef
44.
Henzler D, Dembinski R, Bensberg R, Hochhausen N, Rossaint R, Kuhlen R (2004) Ventilation with biphasic positive airway pressure in experimental lung injury. Intensive Care Med 30:935–943PubMedCrossRef
45.
Henzler D, Pelosi P, Bensberg R, Dembinski R, Quintel M, Pielen V, Rossaint R, Kuhlen R (2006) Effects of partial ventilatory support modalities on respiratory function in severe hypoxemic lung injury. Crit Care Med 34:1738–1745PubMedCrossRef
46.
Hering R, Viehofer A, Zinserling J, Wrigge H, Kreyer S, Berg A, Minot T, Putensen C (2003) Effects of spontaneous breathing during airway pressure release ventilation on intestinal blood flow in experimental lung injury. Anesthesiology 99:1137–1144PubMedCrossRef
47.
Hering R, Zinserling J, Wrigge H, Varelmann D, Berg A, Kreyer S, Putensen C (2005) Effects of spontaneous breathing during airway pressure release ventilation on respiratory work and muscle blood flow in experimental lung injury. Chest 128:2991–2998PubMedCrossRef
48.
Jousela I, Linko K, Makelainen A (1992) A comparison of continuous positive pressure ventilation, combined high frequency ventilation and airway pressure release ventilation on experimental lung injury. Intensive Care Med 18:299–303PubMedCrossRef
49.
Martin L, Wetzel R, Bilenki A (1991) Airway pressure release ventilation in a neonatal lamb model of acute lung injury. Crit Care Med 19:373–378PubMed
50.
Martin L, Wetzel R (1994) Optimal release time during airway pressure release ventilation in neonatal sheep. Crit Care Med 22:486–493PubMed
51.
Neumann P, Hedenstierna G (2001) Ventilatory support by continuous positive airway pressure breathing improves gas exchange as compared with partial ventilatory support with airway pressure release ventilation. Anesthes Analges 92:950–958CrossRef
52.
Neumann P, Wrigge H, Zinserling J, Hinz J, Maripu E, Andersson L, Putensen C, Hedenstierna G (2005) Spontaneous breathing affects the spatial ventilation and perfusion distribution during mechanical ventilatory support. Crit Care Med 33:1090–1095PubMedCrossRef
53.
Okamoto K, Kishi H, Choi H, Sato T (1997) Combination of tracheal gas insufflation and airway pressure release ventilation. Chest 111:1366–1374PubMedCrossRef
54.
Putensen C, Rasanen J, Lopez F (1994) Ventilation–perfusion distribution during mechanical ventilation with superimposed spontaneous breathing in canine lung injury. Am J Respir Crit Care Med 150:101–108PubMed
55.
Putensen C, Rasanen J, Lopez F, Downs J (1994) Effect of interfacing between spontaneous breathing and mechanical cycles on the ventilation–perfusion distribution in canine lung injury. Anesthesiology 81:921–930PubMedCrossRef
56.
Rasanen J, Downs J, Stock M (1988) Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. Chest 93:911–915PubMedCrossRef
57.
Smith R, Smith D (1995) Does airway pressure release ventilation alter lung function after acute lung injury? Chest 107:805–806PubMedCrossRef
58.
Stock M, Downs J, Froclicher D (1987) Airway pressure release ventilation. Crit Care Med 15:462–466PubMedCrossRef
59.
Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, Hedenstierna G (2003) Spontaneous breathing improves lung aeration in oleic acid lung injury. Anesthesiology 99:376–384PubMedCrossRef
60.
Wrigge H, Zinserling J, Neumann P, Muders T, Magnusson A, Putensen C (2005) Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleic-acid-induced lung injury: a randomised controlled computed tomography trial. Crit Care 9:780–789CrossRef
61.
Putensen C, Leon M, Putensen-Himmer G (1994) Timing of pressure release affects power of breathing and minute ventilation during airway pressure release ventilation. Crit Care Med 22:872–878PubMedCrossRef
62.
Baum M, Benzer H, Putensen C, Koller W, Putz G (1989) Biphasic positive airway pressure (BIPAP)—a new form of augmented ventilation. Anaesthetist 38:452–458
63.
Burchardi H (1996) New strategies in mechanical ventilation for acute lung injury. Eur Respir J 9:1063–1072PubMedCrossRef
64.
Calzia E, Radermacher P (1997) Airway pressure release ventilation and biphasic positive airway pressure. A 10-year literature review. Clin Intensive Care 8:296–301CrossRef
65.
Frawley P, Habashi N (2001) Airway pressure release ventilation: theory and practice. AACN Clin Issues 12:234–246PubMedCrossRef
66.
Frawley P, Habashi N (2004) Airway pressure release ventilation and pediatrics: theory and practice. Crit Care Nurs Clin North Am 16:319–336CrossRef
67.
Habashi NM, Andrews P (2004) Ventilator strategies for posttraumatic acute respiratory distress syndrome: airway pressure release ventilation and the role of spontaneous breathing in critically ill patients. Curr Opin Crit Care 10:549–557PubMedCrossRef
68.
Hedenstierna G, Lichtwarck-Aschoff M (2006) Interfacing spontaneous breathing and mechanical ventilation. New insights. Minerva Anestesiol 72:183–198PubMed
69.
70.
Petsinger D, Fernanzez J, Davies J (2006) What is the role of airway pressure release ventilation in the management of acute lung injury. Respir Care Clin N Am 12:483–488PubMed
71.
Putensen C, Hering R, Wrigge H (2002) Controlled versus assisted mechanical ventilation. Curr Opin Crit Care 8:51–57PubMedCrossRef
72.
Putensen C, Wrigge H (2004) Clinical review: biphasic positive airway pressure and airway pressure release ventilation. Crit Care 8:492–497PubMedCrossRef
73.
Putensen C, Muders T, Varelmann D, Wrigge H (2006) The impact of spontaneous breathing during mechanical ventilation. Curr Opin Crit Care 12:13–18PubMedCrossRef
74.
Downs J, Stock M (1987) Airway pressure release ventilation: a new concept in ventilatory support. Crit Care Med 15:459–461PubMedCrossRef
75.
Calzia E, Bein T (2004) Breath by breath, spontaneously or mechanically supported: lessons from biphasic positive airway pressure (BIPAP). Intensive Care Med 30:744–745PubMedCrossRef
Metadaten
Titel
Airway pressure release ventilation and biphasic positive airway pressure: a systematic review of definitional criteria
verfasst von
Louise Rose
Martyn Hawkins
Publikationsdatum
01.10.2008
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 10/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1216-3

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