ArticleIntensive care medicine experimental2015
The effects of airway pressure release ventilation on respiratory mechanics in extrapulmonary lung injury.
Article in Intensive care medicine experimental, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
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Who cites it
37 citing papers in PubMed, 60 citations in OpenAlex.
- 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.Critical care medicine · 2018Trial
- The impact of ventilation mode on systemic inflammation and organ dysfunction in a porcine model of abdominal sepsis-associated acute respiratory distress syndrome.Intensive care medicine experimental · 2026Article
- Influence of airway pressure release ventilation on pulmonary gas exchange using ventilatory ratio.Frontiers in medicine · 2026Article
- Expert recommendations for setting and adjusting airway pressure release ventilation based on clinical experience and basic science evidence.Frontiers in medicine · 2026Article
- Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring.BMC anesthesiology · 2025Article
- Computationally-directed mechanical ventilation in a porcine model of ARDS.Frontiers in physiology · 2025Article
- Atelectrauma can be avoided if expiration is sufficiently brief: evidence from inverse modeling and oscillometry during airway pressure release ventilation.Critical care (London, England) · 2024Article
- Early pathophysiology-driven airway pressure release ventilation versus low tidal volume ventilation strategy for patients with moderate-severe ARDS: study protocol for a randomized, multicenter, controlled trial.BMC pulmonary medicine · 2024Article
- Inconsistent Methods Used to Set Airway Pressure Release Ventilation in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Regression Analysis.Journal of clinical medicine · 2024Review
- Time-Controlled Adaptive Ventilation (TCAV): a personalized strategy for lung protection.Respiratory research · 2024Review
- First Stabilize and then Gradually Recruit: A Paradigm Shift in Protective Mechanical Ventilation for Acute Lung Injury.Journal of clinical medicine · 2023Review
- Ratchet recruitment in the acute respiratory distress syndrome: lessons from the newborn cry.Frontiers in physiology · 2023Article
- Protective ventilation in a pig model of acute lung injury: timing is as important as pressure.Journal of applied physiology (Bethesda, Md. : 1985) · 2022Article
- Unshrinking the baby lung to calm the VILI vortex.Critical care (London, England) · 2022Review
- Time-Controlled Adaptive Ventilation Does Not Induce Hemodynamic Impairment in a Swine ARDS Model.Frontiers in medicine · 2022Article
- Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal.Frontiers in physiology · 2022Review
- The Effects of Airway Pressure Release Ventilation on Pulmonary Permeability in Severe Acute Respiratory Distress Syndrome Pig Models.Frontiers in physiology · 2022Article
- Functional pathophysiology of SARS-CoV-2-induced acute lung injury and clinical implications.Journal of applied physiology (Bethesda, Md. : 1985) · 2021Review
- Mechanical Ventilation in Pediatric and Neonatal Patients.Frontiers in physiology · 2021Review
- Pulmonary Interstitial Matrix and Lung Fluid Balance From Normal to the Acutely Injured Lung.Frontiers in physiology · 2021Review
Corrections and comments
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Authors and funding
13 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLung injury is often studied without consideration for pathologic changes in the chest wall. In order to reduce the incidence of lung injury using preemptive mechanical ventilation, it is important to recognize the influence of altered chest wall mechanics on disease pathogenesis. In this study, we hypothesize that airway pressure release ventilation (APRV) may be able to reduce the chest wall elastance associated with an extrapulmonary lung injury model as compared with low tidal volume (LVt) ventilation.
methodsFemale Yorkshire pigs were anesthetized and instrumented. Fecal peritonitis was established, and the superior mesenteric artery was clamped for 30 min to induce an ischemia/reperfusion injury. Immediately following injury, pigs were randomized into (1) LVt (n = 3), positive end-expiratory pressure (PEEP) 5 cmH2O, V t 6 cc kg(-1), FiO2 21 %, and guided by the ARDSnet protocol or (2) APRV (n = 3), P High 16-22 cmH2O, P Low 0 cmH2O, T High 4.5 s, T Low set to terminate the peak expiratory flow at 75 %, and FiO2 21 %. Pigs were monitored continuously for 48 h. Lung samples and bronchoalveolar lavage fluid were collected at necropsy.
resultsLVt resulted in mild acute respiratory distress syndrome (ARDS) (PaO2/FiO2 = 226.2 ± 17.1 mmHg) whereas APRV prevented ARDS (PaO2/FiO2 = 465.7 ± 66.5 mmHg; p < 0.05). LVt had a reduced surfactant protein A concentration and increased histologic injury as compared with APRV. The plateau pressure in APRV (34.3 ± 0.9 cmH2O) was significantly greater than LVt (22.2 ± 2.0 cmH2O; p < 0.05) yet transpulmonary pressure between groups was similar (p > 0.05). This was because the pleural pressure was significantly lower in LVt (7.6 ± 0.5 cmH2O) as compared with APRV (17.4 ± 3.5 cmH2O; p < 0.05). Finally, the elastance of the lung, chest wall, and respiratory system were all significantly greater in LVt as compared with APRV (all p < 0.05).
conclusionsAPRV preserved surfactant and lung architecture and maintenance of oxygenation. Despite the greater plateau pressure and tidal volumes in the APRV group, the transpulmonary pressure was similar to that of LVt. Thus, the majority of the plateau pressure in the APRV group was distributed as pleural pressure in this extrapulmonary lung injury model. APRV maintained a normal lung elastance and an open, homogeneously ventilated lung without increasing lung stress.
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