What is the evidence for APRV in ARDS?

Intervention
Population
Conclusion

RCT: BILEVEL-APRV

Zhou et al
Inten Care Med (2017)

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  • APRV vs ventilation with low tidal volumes as per ARDSnet protocol
  • APRV settings maintained Pplat <30 and Vt <6 ml/kg PBW
  • 138 patients with ARDS who had received mechanical ventilation for <48 hours
  • APRV group demonstrated:
    • Higher median number of ventilator-free days (19 vs. 2, p <0.001)
    • Shorter duration of ICU stay (p = 0.003)
    • Lower ICU mortality (19.7% vs. 34.3% (P = 0.053)
    The Bottom Line Review

Meta-Analysis

Carsetti et al
Ann Inten Care (2019)

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  • APRV vs. any form of conventional ventilation
  • 5 RCTs with a total of 330 patients
  • Acute hypoxemic respiratory failure with P/F ration <39.9kPa
  • APRV group demonstrated:
    • Reduced duration of mechanical ventilation by 6.04 days (p = 0.003)
    • Lower hospital mortality with a relative difference of 0.16 p = 0.03)