Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, School of Medicine, Yale University, New Haven, CT 06520, USA.
J Trauma Acute Care Surg. 2012 Aug;73(2):507-10. doi: 10.1097/ta.0b013e31825ff653.
Airway pressure release ventilation (APRV) is used both as a rescue therapy for patients with acute lung injury and as a primary mode of ventilation. Unlike assist-control volume (ACV) ventilation that uses spontaneous breathing trials, APRV weaning consists of gradual decreases in supporting pressure. We hypothesized that the APRV weaning process increases total ventilator days compared with those of spontaneous breathing trials-based weaning.
A retrospective review of a Level I trauma center's database identified trauma admissions from January 1, 2007, to December 31, 2010, which required mechanical ventilation for more than 24 hours and survived. Demographics, injuries, in-hospital complications, ventilation mode(s), and total ventilator days were abstracted.
A total of 362 patients fulfilled study entry criteria; 53 patients with more than one ventilator mode change were excluded. Seventy-five patients were successfully liberated from mechanical ventilation on APRV and 234 on ACV. The APRV and ACV groups, respectively, were similar in age (46.1 vs. 44.6 years) and sex (72% vs. 73% male) but differed in Injury Severity Score (20.8 vs. 17.5; p = 0.03). Patients on APRV had higher rates of abdominal compartment syndrome (6.7% vs. 0.8%, p = 0.003) and were more likely to have a higher chest Abbreviated Injury Scale (AIS) score ≥3 (57.3% vs. 30.8%, p < 0.001). Ventilator days were significantly greater in the APRV group (19.6 vs. 10.7 days, p < 0.001). Multiple regression was performed to adjust for the clinical differences between the two groups, identifying APRV as an independent predictor for increased number of ventilator days (B = 6.2 ± 1.5, p < 0.001) in addition to male sex, abdomen AIS score of 3 or higher, spine AIS score of 3 or higher, acute renal failure, and sepsis.
APRV is frequently used for patients who are more severely injured or who develop in-hospital complications such as pneumonia. However, after controlling for potential confounding factors in a multiple regression model, the APRV mode itself seems to increase ventilator days.
气道压力释放通气（APRV）既被用作急性肺损伤患者的抢救治疗，也被用作主要通气模式。与使用自主呼吸试验的辅助控制容量通气（ACV）不同，APRV 撤机包括支持压力的逐渐降低。我们假设与基于自主呼吸试验的撤机相比，APRV 撤机过程会增加总呼吸机使用天数。
回顾性分析了一家一级创伤中心的数据库，该数据库纳入了 2007 年 1 月 1 日至 2010 年 12 月 31 日期间需要机械通气超过 24 小时且存活的创伤患者。提取了患者的人口统计学资料、损伤、院内并发症、通气模式和总呼吸机使用天数。
共有 362 名患者符合研究纳入标准；排除了 53 名有多种呼吸机模式改变的患者。75 名患者成功地从 APRV 中撤机，234 名患者从 ACV 中撤机。APRV 组和 ACV 组在年龄（46.1 岁 vs. 44.6 岁）和性别（72% vs. 73%男性）方面相似，但在损伤严重程度评分方面存在差异（20.8 分 vs. 17.5 分；p = 0.03）。APRV 组患者发生腹腔间隔室综合征的比例更高（6.7% vs. 0.8%，p = 0.003），且更有可能出现更高的胸部简明损伤量表（AIS）评分≥3（57.3% vs. 30.8%，p < 0.001）。APRV 组的呼吸机使用天数明显更长（19.6 天 vs. 10.7 天，p < 0.001）。进行多元回归以调整两组之间的临床差异，结果表明，APRV 是呼吸机使用天数增加的独立预测因素（B = 6.2 ± 1.5，p < 0.001），此外，男性、腹部 AIS 评分≥3、脊柱 AIS 评分≥3、急性肾功能衰竭和脓毒症也是呼吸机使用天数增加的独立预测因素。
APRV 常用于受伤更严重或发生院内并发症（如肺炎）的患者。然而，在多元回归模型中控制潜在混杂因素后，APRV 模式本身似乎会增加呼吸机使用天数。
