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Comparative Study
. 2025 Feb 1;25(1):52.
doi: 10.1186/s12871-025-02904-7.

Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring

Sandra Emily Stoll  1   2   3 , Tobias Leupold  4 , Hendrik Drinhaus  4 , Fabian Dusse  4 , Bernd W Böttiger  4 , Alexander Mathes  4
Affiliations
Comparative Study

Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring

Sandra Emily Stoll et al. BMC Anesthesiol. .

Abstract

Background: APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings.

Methods: This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes.

Results: 20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR - 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO2- removal between both modes.

Conclusion: Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.

Keywords: APRV; ARDS; Atelectrauma; BIPAP; CARDS; COVID; SARS CoV-2; Transpulmonary pressure; VILI; Ventilator associated lung injury.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of the University of Cologne, Germany (21-1553-retro) as a low risk with a waiver of individual patient informed consent due to the retrospective character and the analysis of pseudonymized data. Informed consent was not taken from the individual patient. The study was conducted according to the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Median endinspiratory, Median endexpiratory and median elastance derived (ED) endinspiratory transpulmonary pressure (TPP) in all included study subjects (in mbar) in APRV vs. BIPAP
Fig. 2
Fig. 2
TPP-monitoring in APRV vs. BIPAP (same patient) without spontaneous breathing. The negative endexpiratory TPP In APRV vs. positive in BIPAP indicates an increased risk of atelectasis in APRV- mode
Fig. 3
Fig. 3
Median endinspiratory, Median endexpiratory and median elastance-derived endinspiratory TPP (ED-TPP) in mbar in APRV vs. BIPAP in paralyzed subjects
Fig. 4
Fig. 4
Median endinspiratory, Median endexpiratory and median elastance-derived endinspiratory TPP (ED-TPP) in mbar in APRV vs. BIPAP in non-paralyzed subjects
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References

    1. Mahmoud O, Patadia D, Salonia J. Utilization of Airway Pressure Release Ventilation as a rescue strategy in COVID-19 patients: a retrospective analysis. J Intensive Care Med. 2021;36(10):1194–200. - PMC - PubMed
    1. Gattinoni L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–102. - PMC - PubMed
    1. Gattinoni L, Meissner K, Marini JJ. The baby lung and the COVID-19 era. Intensive Care Med. 2020;46(7):1438–40. - PMC - PubMed
    1. Modrykamien A, Chatburn RL, Ashton RW. Airway pressure release ventilation: an alternative mode of mechanical ventilation in acute respiratory distress syndrome. Cleve Clin J Med. 2011;78(2):101–10. - PubMed
    1. Swindin J, Sampson C, Howatson A. Airway pressure release ventilation. BJA Educ. 2020;20(3):80–8. - PMC - PubMed

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