Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):624-8. doi: 10.1097/TA.0b013e318247668f.
The aim of this article is to review a single institution's experience with airway pressure release ventilation (APRV) with respect to safety, complications, and efficacy at correcting hypercarbia and hypoxemia.
Patients transitioned from either volume- or pressure-targeted ventilation to APRV in a university hospital surgical intensive care unit were retrospectively reviewed. Patients whose ventilator strategy started with APRV were excluded. Abstracted data included age, sex, diagnosis, ventilation parameters, indication for altering the ventilator strategy, laboratory values, and ventilator-associated complications. Data before and after transitioning to APRV were compared using a two-tailed unpaired t test or χ2 test as appropriate; significance assumed for p ≤ 0.05.
Patient mix (n = 38) was 43% trauma, 32% sepsis, 8% cardiac surgery, 12% vascular surgery, and 5% other. Transitioning to APRV was undertaken most often for hypoxemia (88%) and less frequently for hypercarbia (12%). The mean time to correct hypoxemia (SA(O2) >92%) was 7 minutes ± 4 minutes, while the mean time to correct P(CO2) (P(CO2) ≤40 mm Hg) was 42 minutes ± 7 minutes. The mean time to maximal CO2 clearance was 66 minutes ± 12 minutes. The mean minute ventilation decreased on APRV by 3.3 L/min ± 0.9 L/min but achieved superior CO2 clearance and oxygenation. The mean time to FIO2 ≤0.6 was 5.2 hours ± 0.9 hours. Four of the 38 patients developed a pneumothorax. Ninety-seven percent of patients on APRV who were transported out of the intensive care unit using bag-valve ventilation (with appropriate positive end-expiratory pressure valve settings) with P(high) ≥20 cm H2O developed hypoxemia within 5 minutes. Hundred percent of patients with a P(high) ≤20 cm H2O were safely hand ventilated during transport without developing hypoxemia.
APRV is a safe mode of ventilation for hypoxemic or hypercarbic respiratory failure. Improvements in PO2 and PCO2 are achieved at lower minute ventilations than with volume- or pressure-targeted modes.
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本文旨在回顾单一机构在气道压力释放通气（APRV）方面的经验，包括安全性、并发症以及纠正高碳酸血症和低氧血症的疗效。
回顾性分析了一家大学医院外科重症监护病房从容量或压力目标通气转为 APRV 的患者。排除了呼吸机策略起始即为 APRV 的患者。提取的数据包括年龄、性别、诊断、通气参数、改变通气策略的指征、实验室值和呼吸机相关并发症。使用双侧非配对 t 检验或适当的 χ2 检验比较转为 APRV 前后的数据；假设 p ≤ 0.05 有统计学意义。
患者构成（n = 38）为创伤 43%、脓毒症 32%、心脏手术 8%、血管手术 12%和其他 5%。转为 APRV 最常见的指征是低氧血症（88%），较少见的是高碳酸血症（12%）。纠正低氧血症（SaO2 >92%）的中位时间为 7 分钟 ± 4 分钟，而纠正高碳酸血症（PCO2 ≤40mmHg）的中位时间为 42 分钟 ± 7 分钟。达到最大 CO2 清除的中位时间为 66 分钟 ± 12 分钟。APRV 时每分钟通气量平均降低 3.3 L/min ± 0.9 L/min，但 CO2 清除和氧合效果更佳。FiO2 ≤0.6 的中位时间为 5.2 小时 ± 0.9 小时。38 例患者中有 4 例发生气胸。在使用袋阀通气（具有适当的呼气末正压阀设置）转送出重症监护病房的 APRV 患者中，97%的患者 P(high)≥20cmH2O，5 分钟内发生低氧血症。在转运过程中，所有 P(high)≤20cmH2O 的患者均安全地进行手控通气，未发生低氧血症。
APRV 是治疗低氧血症或高碳酸血症性呼吸衰竭的一种安全通气模式。与容量或压力目标通气模式相比，APRV 可在更低的分钟通气量下改善 PaO2 和 PaCO2。
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