Year : 2021 | Volume
: 16 | Issue : 3 | Page : 245--252
The efficacy of airway pressure release ventilation in acute respiratory distress syndrome adult patients: A meta-analysis of clinical trials
Fatmah Othman1, Noura Alsagami2, Reem Alharbi2, Yara Almuammer2, Shatha Alshahrani2, Taha Ismaeil2
1 Department of Research, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
2 King Abdullah International Medical Research Center; Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
BACKGROUND: To recruit poorly ventilated lung areas by providing active and adequate oxygenation is a core aspect of treating patients with acute respiratory distress syndrome (ARDS). The airway pressure release ventilation (APRV) mode is increasingly accepted as a means of supporting patients with ARDS. This study aimed to determine whether the APRV mode is effective in improving oxygenation, compared to conventional ventilation, in adult ARDS patients.
METHODS: We conducted the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for clinical trials in PubMed, Embase, Web of Science, and the Cochrane Library until April 2019. We included all studies comparing APRV and other conventional mechanical ventilation modes for adult ARDS patients. Our primary outcome was oxygenation status (defined as the day 3 PaO2/FiO2 ratio). The secondary outcomes were the length of stay (LOS) in the intensive care unit (ICU) and mortality. Sensitivity analyses were performed including studies with conventional low-tidal volume ventilation as a comparator ventilation strategy.
RESULTS: We included six clinical trials enrolling a total of 375 patients. The day 3 PaO2/FiO2 was reported in all the studies, and it was significantly higher in patients receiving APRV (mean difference [MD] 51.9 mmHg, 95% confidence intervals (CI) 8.2–95.5, P = 0.02, I2 = 92%). There was no significant difference in mortality between APRV and the other conventional ventilator modes (risk difference 0.07, 95% CI: −0.01–0.15, P = 0.08, I2 0%). The point estimate for the effect of APRV on the LOS in ICU indicated a significant reduction in the ICU LOS for the APRV group compared to the counter group (MD 3.1 days, 95% CI 0.4–5.9, P = 0.02, I2 = 53%).
CONCLUSION: In this study, using the APRV mode may improve oxygenation on day 3 and contribute to reducing the LOS in ICU. However, it is difficult to draw a clinical message about APRV, and well-designed clinical trials are required to investigate this issue.
Dr. Fatmah Othman
King Saud Bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481
|How to cite this article:|
Othman F, Alsagami N, Alharbi R, Almuammer Y, Alshahrani S, Ismaeil T. The efficacy of airway pressure release ventilation in acute respiratory distress syndrome adult patients: A meta-analysis of clinical trials.Ann Thorac Med 2021;16:245-252
|How to cite this URL:|
Othman F, Alsagami N, Alharbi R, Almuammer Y, Alshahrani S, Ismaeil T. The efficacy of airway pressure release ventilation in acute respiratory distress syndrome adult patients: A meta-analysis of clinical trials. Ann Thorac Med [serial online] 2021 [cited 2021 Oct 21 ];16:245-252
Available from: https://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2021;volume=16;issue=3;spage=245;epage=252;aulast=Othman;type=0