The effect of APRV-LTV mechanical ventilation mode on SpO2 and ventilation indices in patients with COVID-19

Background & Aim: Mechanical ventilation is a life-saving method for acute respiratory distress syndrome. The present study aimed to investigate the impact of airway pressure release ventilation-low tidal volume mode on COVID-19 patients’ peripheral capillary oxygen saturation and ventilation indices. Methods & Materials: This clinical trial was conducted on 70 COVID-19 patients hospitalized in the Intensive care unit in Qom, Iran. Patients were selected using convenience sampling and randomly allocated to intervention and control groups. In the control group, patients were ventilated using synchronized intermittent mandatory ventilation mode, and in the intervention group, patients were ventilated using airway pressure release ventilation-low tidal volume mode. Patients’ peripheral capillary oxygen saturation and ventilation indices were checked and recorded before and after the intervention. The data were analyzed using SPSS 11.5. Results: According to the results of the repeated-measures ANOVA test before the intervention and the 2 and 4 hours after the intervention, there were no significant differences between the intervention and control groups regarding the fraction of inspired oxygen, volume minute per minute, and peripheral capillary oxygen saturation (P>0.05). However, in the intervention group compared to the control group, the mean of PIP was significantly reduced (P<0.05). Conclusion: In patients with COVID-19, the two modes of mechanical ventilation, APRV, and control, had no significant differences in the fraction of inspired oxygen, volume minute per minute, and peripheral capillary oxygen saturation. However, the mean peak inspiratory pressure reduction in the intervention group was greater than that in the control group. Considering that several factors can affect peripheral capillary oxygen saturation and ventilation indices, these results should be considered with caution.

[1]  D. McAuley,et al.  Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management , 2022, The Lancet.

[2]  Bo Wang,et al.  Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome? , 2022, Journal of Intensive Medicine.

[3]  A. Ahmadi,et al.  Controlled Modes Can Be as Effective as CPAP and BiPAP in Non-invasive Ventilation in COVID-19 , 2021, Anesthesiology and pain medicine.

[4]  B. Romito,et al.  Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies , 2020, Clinical medicine insights. Circulatory, respiratory and pulmonary medicine.

[5]  B. Singer,et al.  Invasive Mechanical Ventilation , 2018, Southern medical journal.

[6]  Samuel M. Brown,et al.  Randomized Feasibility Trial of a Low Tidal Volume-Airway Pressure Release Ventilation Protocol Compared With Traditional Airway Pressure Release Ventilation and Volume Control Ventilation Protocols , 2018, Critical care medicine.

[7]  Pedro Amorim,et al.  Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts , 2018, Intensive Care Medicine.

[8]  Jian-feng Xie,et al.  Acute Respiratory Distress Syndrome: Challenge for Diagnosis and Therapy , 2018, Chinese medical journal.

[9]  Bo Wang,et al.  Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome , 2017, Intensive Care Medicine.

[10]  N. Habashi,et al.  Personalizing mechanical ventilation according to physiologic parameters to stabilize alveoli and minimize ventilator induced lung injury (VILI) , 2017, Intensive Care Medicine Experimental.

[11]  N. Habashi,et al.  The 30-year evolution of airway pressure release ventilation (APRV) , 2016, Intensive Care Medicine Experimental.

[12]  N. Katsikogiannis,et al.  Barotrauma and pneumothorax. , 2015, Journal of thoracic disease.

[13]  T. Scalea,et al.  Preemptive Application of Airway Pressure Release Ventilation Prevents Development of Acute Respiratory Distress Syndrome in a Rat Traumatic Hemorrhagic Shock Model , 2013, Shock.

[14]  K. Ota,et al.  Practical use of airway pressure release ventilation for severe ARDS--a preliminary report in comparison with a conventional ventilatory support. , 2009, Hiroshima journal of medical sciences.

[15]  D. Needham,et al.  Review of A Large Clinical Series: Sedation and Analgesia Usage with Airway Pressure Release and Assist-control Ventilation for Acute Lung Injury , 2008, Journal of intensive care medicine.

[16]  Ehab Daoud,et al.  Airway pressure release ventilation , 2007, Annals of thoracic medicine.

[17]  N Mutz,et al.  Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. , 2001, American journal of respiratory and critical care medicine.

[18]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[19]  D. Wiegand.  AACN Procedure Manual for High Acuity, Progressive and Critical Care , 2017 .

[20]  M. Stoler,et al.  Airway pressure release ventilation during ex vivo lung perfusion attenuates injury , 2017, The Journal of thoracic and cardiovascular surgery.

[21]  M. Sarkar,et al.  Mechanisms of hypoxemia , 2017, Lung India : official organ of Indian Chest Society.

[22]  A. A. Ali,et al.  Pressure regulated volume controlled ventilation versus synchronized intermittent mandatory ventilation in COPD patients suffering from acute respiratory failure , 2016 .

[23]  S. Donn,et al.  Synchronized Intermittent Mandatory Ventilation , 2012 .