Effect of airway pressure release ventilation on the hospital mortality of patients with acute respiratory distress syndrome: a cumulative meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YUE Weigang ¹ , JIANG Youfei ¹ , YUAN Peng ¹ , YIN Ruiyuan ¹ , FENG Xin ¹ , ZHANG Zhigang ¹ , TIAN Jinhui ² , LI Bin ¹

1. Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. Evidence Based Medicine Center of Lanzhou University, Key Laboratory of Evidence Based Medicine and Clinical Transformation of Gansu Province, Lanzhou 730000, P. R. China;

Corresponding?author：

YUE Weigang, Email: yueweigang5963@163.com

Keywords：

Airway pressure release ventilation; Traditional mechanical ventilation; Acute respiratory distress syndrome; Cumulative meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202210021

Video：

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Objective To evaluate the effect of airway pressure release ventilation (APRV) on the hospital mortality of patients with acute respiratory distress syndrome (ARDS) by using cumulative meta-analysis. Methods The PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) related to the objective from inception to June 30, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A cumulative meta-analysis was then performed by using StataSE 12.0 software. Results A total of 9 RCTs involving 533 patients were included. The results of meta-analysis showed that APRV could reduce the hospital mortality of patients with ARDS (RR=0.70, 95%CI 0.54 to 0.91, P<0.01) compared with traditional mechanical ventilation. Conclusion Current evidence shows that APRV can reduce the hospital mortality of patients with ARDS. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： YUE Weigang, JIANG Youfei, YUAN Peng, YIN Ruiyuan, FENG Xin, ZHANG Zhigang, TIAN Jinhui, LI Bin. Effect of airway pressure release ventilation on the hospital mortality of patients with acute respiratory distress syndrome: a cumulative meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 517-521. doi: 10.7507/1672-2531.202210021 Copy

1.	Kollisch-Singule M, Jain S, Andrews P, et al. Effect of airway pressure release ventilation on dynamic alveolar heterogeneity. JAMA Surg, 2016, 151(1): 64-72.
2.	Andrews PL, Shiber JR, Jaruga-Killeen E, et al. Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature. J Trauma Acute Care Surg, 2013, 75(4): 635-641.
3.	Mallory P, Cheifetz I. A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Rev Respir Med, 2020, 14(3): 307-315.
4.	Putensen C, Zech S, Wrigge H, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med, 2001, 164(1): 43-49.
5.	Varpula T, Valta P, Niemi R, et al. Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome. Acta Anaesthesiol Scand, 2004, 48(6): 722-731.
6.	Maxwell RA, Green JM, Waldrop J, et al. A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure. J Trauma, 2010, 69(3): 501-510.
7.	宋邵華, 田惠玉, 楊秀芬, 等. 氣道壓力釋放通氣應用于急性肺損傷/急性呼吸窘迫綜合征患者的臨床研究. 中華危重病急救醫學, 2016, 28(1): 15-21.
8.	Li JQ, Li N, Han GJ, et al. Clinical research about airway pressure release ventilation for moderate to severe acute respiratory distress syndrome. Eur Rev Med Pharmacol Sci, 2016, 20(12): 2634-2641.
9.	Zhou Y, Jin X, Lv Y, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med, 2017, 43(11): 1648-1659.
10.	Hirshberg EL, Lanspa MJ, Peterson J, 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. Crit Care Med, 2018, 46(12): 1943-1952.
11.	岳偉崗, 向飛, 張瑩, 等. 急性呼吸窘迫綜合征患者早期應用氣道壓力釋放通氣的療效. 中華危重癥醫學雜志(電子版), 2020, 13(2): 93-99.
12.	Kü?ük MP, ?ztürk ?E, ?lkaya NK, et al. The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial. Braz J Anesthesiol, 2022, 72(1): 29-36.
13.	Davies SW, Leonard KL, Falls RK, et al. Lung protective ventilation (ARDSNet) versus airway pressure release ventilation: ventilatory management in a combined model of acute lung and brain injury. J Trauma Acute Care Surg, 2015, 78(2): 240-249.
14.	Kreyer S, Baker WL, Scaravilli V, et al. Assessment of spontaneous breathing during pressure controlled ventilation with superimposed spontaneous breathing using respiratory flow signal analysis. J Clin Monit Comput, 2021, 35(4): 859-868.
15.	Mehaffey JH, Charles EJ, Sharma AK, et al. Airway pressure release ventilation during ex vivo lung perfusion attenuates injury. J Thorac Cardiovasc Surg, 2017, 153(1): 197-204.
16.	Needham DM, Yang T, Dinglas VD, et al. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome: a prospective cohort study. Am J Respir Crit Care Med, 2015, 191(2): 177-185.
17.	Nieman GF, Al-Khalisy H, Kollisch-Singule M, et al. A physiologically informed strategy to effectively open, stabilize, and protect the acutely injured lung. Front Physiol, 2020, 11: 227.
18.	Daoud EG, Chatburn RL. Comparing surrogates of oxygenation and ventilation between airway pressure release ventilation and biphasic airway pressure in a mechanical model of adult respiratory distress syndrome. Respir Investig, 2014, 52(4): 236-241.
19.	Kollisch-Singule M, Emr B, Smith B, et al. Mechanical breath profile of airway pressure release ventilation: the effect on alveolar recruitment and microstrain in acute lung injury. JAMA Surg, 2014, 149(11): 1138-1145.

1. Kollisch-Singule M, Jain S, Andrews P, et al. Effect of airway pressure release ventilation on dynamic alveolar heterogeneity. JAMA Surg, 2016, 151(1): 64-72.
2. Andrews PL, Shiber JR, Jaruga-Killeen E, et al. Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature. J Trauma Acute Care Surg, 2013, 75(4): 635-641.
3. Mallory P, Cheifetz I. A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Rev Respir Med, 2020, 14(3): 307-315.
4. Putensen C, Zech S, Wrigge H, et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med, 2001, 164(1): 43-49.
5. Varpula T, Valta P, Niemi R, et al. Airway pressure release ventilation as a primary ventilatory mode in acute respiratory distress syndrome. Acta Anaesthesiol Scand, 2004, 48(6): 722-731.
6. Maxwell RA, Green JM, Waldrop J, et al. A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure. J Trauma, 2010, 69(3): 501-510.
7. 宋邵華, 田惠玉, 楊秀芬, 等. 氣道壓力釋放通氣應用于急性肺損傷/急性呼吸窘迫綜合征患者的臨床研究. 中華危重病急救醫學, 2016, 28(1): 15-21.
8. Li JQ, Li N, Han GJ, et al. Clinical research about airway pressure release ventilation for moderate to severe acute respiratory distress syndrome. Eur Rev Med Pharmacol Sci, 2016, 20(12): 2634-2641.
9. Zhou Y, Jin X, Lv Y, et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med, 2017, 43(11): 1648-1659.
10. Hirshberg EL, Lanspa MJ, Peterson J, 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. Crit Care Med, 2018, 46(12): 1943-1952.
11. 岳偉崗, 向飛, 張瑩, 等. 急性呼吸窘迫綜合征患者早期應用氣道壓力釋放通氣的療效. 中華危重癥醫學雜志(電子版), 2020, 13(2): 93-99.
12. Kü?ük MP, ?ztürk ?E, ?lkaya NK, et al. The effect of preemptive airway pressure release ventilation on patients with high risk for acute respiratory distress syndrome: a randomized controlled trial. Braz J Anesthesiol, 2022, 72(1): 29-36.
13. Davies SW, Leonard KL, Falls RK, et al. Lung protective ventilation (ARDSNet) versus airway pressure release ventilation: ventilatory management in a combined model of acute lung and brain injury. J Trauma Acute Care Surg, 2015, 78(2): 240-249.
14. Kreyer S, Baker WL, Scaravilli V, et al. Assessment of spontaneous breathing during pressure controlled ventilation with superimposed spontaneous breathing using respiratory flow signal analysis. J Clin Monit Comput, 2021, 35(4): 859-868.
15. Mehaffey JH, Charles EJ, Sharma AK, et al. Airway pressure release ventilation during ex vivo lung perfusion attenuates injury. J Thorac Cardiovasc Surg, 2017, 153(1): 197-204.
16. Needham DM, Yang T, Dinglas VD, et al. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome: a prospective cohort study. Am J Respir Crit Care Med, 2015, 191(2): 177-185.
17. Nieman GF, Al-Khalisy H, Kollisch-Singule M, et al. A physiologically informed strategy to effectively open, stabilize, and protect the acutely injured lung. Front Physiol, 2020, 11: 227.
18. Daoud EG, Chatburn RL. Comparing surrogates of oxygenation and ventilation between airway pressure release ventilation and biphasic airway pressure in a mechanical model of adult respiratory distress syndrome. Respir Investig, 2014, 52(4): 236-241.
19. Kollisch-Singule M, Emr B, Smith B, et al. Mechanical breath profile of airway pressure release ventilation: the effect on alveolar recruitment and microstrain in acute lung injury. JAMA Surg, 2014, 149(11): 1138-1145.

Chinese Journal of Evidence-Based Medicine

Effect of airway pressure release ventilation on the hospital mortality of patients with acute respiratory distress syndrome: a cumulative meta-analysis

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