Expert recommendations for setting and adjusting airway pressure release ventilation based on clinical experience and...

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Mechanical Ventilation

Background:

• Acute Respiratory Distress Syndrome (ARDS) management requires precise mechanical ventilation strategies.
• Airway Pressure Release Ventilation (APRV) is a lung-protective ventilation strategy with specific setting considerations.
• Evidence-based guidance for APRV settings in ARDS is crucial for optimizing patient care.

Purpose of the Study:

• To provide expert consensus guidance on the optimal setting and adjustment of APRV in adult patients with ARDS.
• To develop evidence-based recommendations integrating clinical experience and scientific evidence for APRV use.
• To establish a protocol for APRV adjustment in patients with acute lung injury (ALI) and ARDS.

Main Methods:

• A panel of experts in lung physiology and APRV convened for a roundtable discussion.
• Literature review on the physiological basis and research of APRV as a lung-protective strategy was conducted.
• The Nominal Group Technique was used to facilitate iterative consensus discussions and reach agreement on APRV settings.

Main Results:

• Consensus was reached on initial APRV settings for ALI/ARDS, including P_High, T_High, P_Low, and T_Low calculations.
• Specific recommendations were made for titrating APRV settings based on physiological changes.
• Injurious APRV settings that could impair gas exchange or cause lung instability were identified.

Conclusions:

• A protocol for adjusting APRV settings was developed based on expert experience and clinical/scientific evidence for ALI/ARDS patients.
• Optimizing lung-protective settings in APRV mode has the potential to improve patient outcomes.
• These recommendations serve as an Expert Recommendation and Position Statement for APRV management in ARDS.