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Table 3 Summary of human trials using F-APRV

From: The 30-year evolution of airway pressure release ventilation (APRV)

First author Year n Study design %CPAP TLow Findings
Garner [31] 1988 14 Crossover
CPPV baseline with APRV wean
N/A 1.5 s APRV maintained similar oxygenation with >50 % reduced PIP
Rasanen [40] 1991 50 Crossover
PEEP titrated CPPV vs. APRV
50 % 1.5 s APRV maintained similar oxygenation with >50 % reduced PIP
Cane [28] 1991 18 Crossover
CPPV vs. APRV
67 % 1.5 s APRV maintained similar oxygenation and cardiopulmonary function with reduced PIP
Davis [3] 1993 15 Crossover
CPPV vs. APRV
32 % 2.6 ± 0.6 APRV maintained similar oxygenation with >50 % reduced PIP and reduced PEEP
Chiang [29] 1994 18 Crossover
CPPV vs. APRV
66 % 1.5 s APRV maintained similar oxygenation with >50 % reduced PIP
Sydow [42] 1994 18 Crossover
CPPV vs. APRV
80 % 0.5–0.7 APRV maintained similar oxygenation with decreased A-a gradient after 8 h and reduced PIP
Bratzke [27] 1998 20 Crossover
CPPV vs. APRV
88 % 1 APRV maintained similar oxygenation with reduced PIP
Kaplan [36] 2001 12 Crossover
Inverse ratio PPV vs. APRV
85 % 0.8 APRV is safe, decreases PIP and need for sedation/paralytics/pressors, increases CI
Putensen [39] 2001 30 Randomized prospective
CPPV vs. APRV
Identical to CPPV Exp flow 0 APRV + SB maintained increased oxygenation, CI, and pulmonary compliance with reduced ALI/ARDS incidence and sedative requirements
Schultz [41] 2001 15 Crossover
CPPV vs. APRV
N/A N/A APRV maintained similar oxygenation with >50 % reduced PIP
Wrigge [45] 2001 14 Randomized prospective
APRV +/− automatic tube compensation
N/A N/A APRV with tube compensation increased end-expiratory lung volume and minute ventilation without affecting oxygenation or cardiopulmonary status
Hering [34] 2002 12 Crossover
APRV +/− SB
N/A N/A APRV + SB had increased renal blood flow and glomerular filtration rate
Varpula [43] 2003 33 Randomized prospective
CPPV vs. APRV
N/A Exp flow 0 APRV feasible in prone positioning and increased oxygenation at 24 h
Varpula [44] 2004 58 Randomized prospective
CPPV vs. APRV
80 % 1 APRV had similar mortality and ventilator free days
Dart [30] 2005 46 Crossover
CPPV vs. APRV
N/A 40–50 % PEF APRV reduced PIP and increased oxygenation
Liu [37] 2009 58 Retrospective case-control
CPPV vs. APRV
67 % ~1.5 APRV reduced pressor use/A-a gradient and increased oxygenation
Kamath [35] 2010 11 Retrospective cohort
CPPV vs. APRV
70 % 1.2 ± 0.9 APRV had no adverse effects on blood pressure or urine output
Gonzalez [32] 2010 468 Case matched retrospective
CPPV vs. APRV
70 % N/A APRV maintained similar oxygenation with reduced PIP and associated increased tracheostomy rate
Maxwell [38] 2010 63 Randomized prospective
LTV vs. APRV
N/A 25–75 % PEF APRV had similar physiological parameters despite increased disease severity at baseline
Hanna [33] 2011 45 Retrospective case series
CPPV vs. APRV
N/A N/A APRV had increased P/F Ratio, lung procurement rate with similar graft survival rate
Maung [46] 2012 38 Retrospective case series
APRV
85 % 0.8–1 Switching from CPPV to APRV improved oxygenation and decreased PCO2 without hemodynamic compromise
Maung [47] 2012 362 Retrospective case series
CPPV vs. APRV
N/A N/A APRV had increased ventilator days.
Testerman [48] 2013 48 Case-matched retrospective
APRV; obese vs. nonobese
N/A N/A APRV in morbidly obese similar to nonobese, though morbidly obese required extended care after discharge more often
  1. Number of studies: 23
  2. T Low time at low pressure, CPPV conventional positive pressure ventilation, LTV low tidal volume ventilation, CPAP continuous positive airway pressure, PEF peak expiratory flow, SB spontaneous breathing, PEEP positive end-expiratory pressure, PIP peak inspiratory pressure