• Takeshi Yoshida, Hiroshi Rinka, Arito Kaji, Akira Yoshimoto, Hideki Arimoto, Toshinori Miyaichi, and Masanori Kan.
• Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. doctor@mvj.biglobe.ne.jp
• Anesth. Analg. 2009 Dec 1;109(6):1892-900.

BackgroundIn this study, we sought to determine which mode, airway pressure release ventilation (APRV) or pressure support ventilation (PSV), decreases atelectasis more in patients with acute lung injury/acute respiratory distress syndrome (ARDS).MethodsThis was a retrospective study in the intensive care unit. Between 2006 and 2007, we identified 18 patients with acute lung injury/ARDS who received either APRV or PSV and had a helical computed tomography scan twice in 3 days.ResultsComputed tomography data from the APRV and PSV groups (n = 9 each) were analyzed for 3-dimensional reconstruction and volumetry. Aerated lung regions (normally aerated, poorly aerated, nonaerated, and hyperinflated) were identified by their densities in Hounsfield units. The Pao(2)/Fio(2) ratio and alveolar-arteriolar oxygen gradient after ventilation were improved in both groups (P = 0.008); however, the improvements in the APRV group exceeded those in the PSV group when delivered with equal mean airway pressure (P = 0.018 and 0.015, respectively). Atelectasis decreased significantly from 41% (range, 17%-68%) to 19% (range, 6%-40%) (P = 0.008) and normally aerated volume increased significantly from 29% (range, 13%-41%) to 43% (range, 25%-56%) (P = 0.008) in the APRV group, whereas lung volume did not change in the PSV group.ConclusionsSpontaneous ventilation during APRV improves lung aeration by decreasing atelectasis. PSV for gas exchange is effective but not sufficient to improve lung aeration. These results indicate that APRV is more efficient than PSV as a mode of primary ventilatory support to decrease atelectasis in patients with ARDS.

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