Airway Pressure Release Ventilation for Acute Respiratory Distress Syndrome: An Update

Key Message

1. Evidence suggested there was no significant difference in mortality between patients with or at risk of acute respiratory distress syndrome treated with airway pressure release ventilation versus other mechanical ventilation strategies.
2. The evidence of the clinical effectiveness of airway pressure release ventilation in patients with or at risk of acute respiratory distress syndrome is uncertain for several outcomes (length of intensive care unit stay, oxygenation, ventilator-free days, mean arterial pressure). Evidence from some studies suggested there was a significant benefit favouring airway pressure release ventilation versus other mechanical ventilation strategies for these outcomes, other studies suggested there was a significant benefit favouring other mechanical ventilation strategies, and some studies found no significant differences between treatment groups.
3. Results from 1 study suggested there were no significant differences in incidence of acute respiratory distress syndrome between patients treated with airway pressure release ventilation versus pressure-controlled synchronized intermittent mandatory ventilation and pressure support.
4. Evidence suggested there was no significant difference in tracheostomy between patients with or at risk of acute respiratory distress syndrome treated with airway pressure release ventilation versus control. In 1 study significantly more patients treated with airway pressure release ventilation experienced severe hypercapnia than those treated with low tidal volume ventilation.
5. One guideline suggests considering the use of airway pressure release ventilation in patients without severe acute respiratory distress syndrome.