A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure

Robert Maxwell, John M. Green, Jimmy Waldrop, Benjamin W. Dart, Philip W. Smith, Donald Brooks, Patricia L. Lewis, Donald E. Barker

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Airway pressure release ventilation (APRV) is a mode of mechanical ventilation, which has demonstrated potential benefits in trauma patients. We therefore sought to compare relevant pulmonary data and safety outcomes of this modality to the recommendations of the Adult Respiratory Distress Syndrome Network. Methods: Patients admitted after traumatic injury requiring mechanical ventilation were randomized under a 72-hour waiver of consent to a respiratory protocol for APRV or low tidal volume ventilation (LOVT). Data were collected regarding demographics, Injury Severity Score, oxygenation, ventilation, airway pressure, failure of modality, tracheostomy, ventilator-associated pneumonia, ventilator days, length of stay (LOS), pneumothorax, and mortality. Results: Sixty-three patients were enrolled during a 21-month period ending in February 2006. Thirty-one patients were assigned to APRV and 32 to LOVT. Patients were well matched for demographic variables with no differences between groups. Mean Acute Physiology and Chronic Health Evaluation II score was higher for APRV than LOVT (20.5 ± 5.35 vs. 16.9 ± 7.17) with a p value = 0.027. Outcome variables showed no differences between APRV and LOVT for ventilator days (10.49 days ± 7.23 days vs. 8.00 days ± 4.01 days), ICU LOS (16.47 days ± 12.83 days vs. 14.18 days ± 13.26 days), pneumothorax (0% vs. 3.1%), ventilator-associated pneumonia per patient (1.00 ± 0.86 vs. 0.56 ± 0.67), percent receiving tracheostomy (61.3% vs. 65.6%), percent failure of modality (12.9% vs. 15.6%), or percent mortality (6.45% vs. 6.25%). Conclusions: For patients sustaining significant trauma requiring mechanical ventilation for greater than 72 hours, APRV seems to have a similar safety profile as the LOVT. Trends for APRV patients to have increased ventilator days, ICU LOS, and ventilator-associated pneumonia may be explained by initial worse physiologic derangement demonstrated by higher Acute Physiology and Chronic Health Evaluation II scores.

Original languageEnglish (US)
Pages (from-to)501-510
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number3
DOIs
StatePublished - Sep 1 2010
Externally publishedYes

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Continuous Positive Airway Pressure
Tidal Volume
Respiratory Insufficiency
Wounds and Injuries
Ventilator-Associated Pneumonia
Mechanical Ventilators
Artificial Respiration
Length of Stay
APACHE
Tracheostomy
Pneumothorax
Demography
Safety
Injury Severity Score
Mortality
Adult Respiratory Distress Syndrome
Ventilation
Pressure
Lung

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure. / Maxwell, Robert; Green, John M.; Waldrop, Jimmy; Dart, Benjamin W.; Smith, Philip W.; Brooks, Donald; Lewis, Patricia L.; Barker, Donald E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 3, 01.09.2010, p. 501-510.

Research output: Contribution to journalArticle

Maxwell, Robert ; Green, John M. ; Waldrop, Jimmy ; Dart, Benjamin W. ; Smith, Philip W. ; Brooks, Donald ; Lewis, Patricia L. ; Barker, Donald E. / A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 3. pp. 501-510.
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AU - Brooks, Donald

AU - Lewis, Patricia L.

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