Dart Benjamin W, Maxwell Robert A, Richart Charles M, Brooks Donald K, Ciraulo David L, Barker Donald E, Burns R Phillip
Department of Surgery, Division of Surgical Critical Care, University of Tennessee College of Medicine, Chattanooga, Tennessee 37403, USA.
J Trauma. 2005 Jul;59(1):71-6. doi: 10.1097/00005373-200507000-00010.
Airway pressure-release ventilation (APRV) is a pressure-limited, time-cycled mode of mechanical ventilation. The purpose of this study was to evaluate our initial experience with the use of APRV in acutely injured, ventilated patients.
Since March 2003, APRV has been used selectively in adult trauma patients with or at risk for acute lung injury/acute respiratory distress syndrome. Data were obtained before and during the 72 hours after switching to APRV. A retrospective analysis of these data was then performed.
Complete data were available on 46 of 60 patients (77%) for the first 72 hours of APRV. Before APRV, the average Pao2/Fio2 ratio was 243 and the average peak airway pressure was 28 cm H2O. Peak airway pressure decreased 19% (p = 0.001), Pao2/Fio2 improved by 23% (p = 0.017) and release tidal volumes improved by 13% (p = 0.020) over the course of the analysis.
APRV significantly improved oxygenation by alveolar recruitment and allowed for a reduction in peak airway pressures. This relatively new modality had favorable results and appears to be an effective alternative for lung recruitment in traumatically injured patients at risk for acute lung injury/acute respiratory distress syndrome.
气道压力释放通气（APRV）是一种压力限制、时间切换的机械通气模式。本研究的目的是评估我们在急性受伤的机械通气患者中使用APRV的初步经验。
自2003年3月以来，APRV已被选择性地用于患有或有急性肺损伤/急性呼吸窘迫综合征风险的成年创伤患者。在切换至APRV之前及之后72小时内获取数据。然后对这些数据进行回顾性分析。
60例患者中有46例（77%）在APRV治疗的最初72小时有完整数据。在使用APRV之前，平均动脉血氧分压/吸入氧分数值（Pao2/Fio2）为243，平均气道峰压为28 cm H2O。在分析过程中，气道峰压下降了19%（p = 0.001），Pao2/Fio2提高了23%（p = 0.017），释放潮气量提高了13%（p = 0.020）。
APRV通过肺泡复张显著改善了氧合，并降低了气道峰压。这种相对较新的模式取得了良好的效果，似乎是在有急性肺损伤/急性呼吸窘迫综合征风险的创伤患者中进行肺复张的一种有效替代方法。
