• BMC anesthesiology · Feb 2025

    Comparative Study

    Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring.

    • Sandra Emily Stoll, Tobias Leupold, Hendrik Drinhaus, Fabian Dusse, Bernd W Böttiger, and Alexander Mathes.
    • Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. sandra.stoll@uk-koeln.de.
    • BMC Anesthesiol. 2025 Feb 1; 25 (1): 5252.

    BackgroundAPRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings.MethodsThis retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes.Results20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR - 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO2- removal between both modes.ConclusionDespite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.© 2025. The Author(s).

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