Experimental study of airway pressure release ventilation in the treatment of acute respiratory distress syndrome

摘要

Airway pressure release ventilation (APRV) is a ventilator mode which has demonstrated potential benefits in acute respiratory distress syndrome (ARDS) patients. We therefore sought to compare relevant pulmonary data and safety outcomes of this mode to the conventional ventilation and sustained inflation. Canines admitted after intravenous injection of oleic acid requiring mechanical ventilation were randomly divided into 3 groups (n=6), namely conventional ventilation group, low tidal volume ventilation with recruitment group (LTV+SI) and APRV group. The changes of oxygenation, ventilation, airway pressure, inflammatory reaction and hemo-dynamics at the basic state were observed at 0, 1, 2 and 4 h during the experiment. The levels of PaO2/FiO(2), in APRV group were higher than LTV+SI group at 2 and 4 h (P<0.05). In APRV group, the PCO2 levels at 1, 2 and 4 h is much lower than LTV+SI group (P<0.05). Outcome variables showed no differences between APRV, LVT+SI and conventional mechanical ventilation for plateau airway pressure (24 1 vs. 29 3 vs. 25 4), mean arterial pressure (92.9 +/- 16.5 vs. 85.8 +/- 21.4 vs. 88.7 +/- 24.4), cardiac index (4.3 +/- 1.7 vs. 3.5 +/- 1.9 vs. 3.4 +/- 2.1), ERO2 (13.4 +/- 10.3 vs. 16.1 +/- 6.8 vs. 17.6 +/- 9.1), lac (2.5 +/- 1.7 vs. 3.1 +/- 1.6 vs. 3.9 +/- 1.9), tumor necrosis factor (TNE)-alpha (132 11 vs. 140 6 vs. 195 13) and matrix metalloproteinase (MMP)-9. For canines sustaining acute respiratory distress syndrome requiring mechanical ventilation, APRV can significantly improve oxygenation and keep hemodynamic stability compared with LTV+SI. The results of TNF-alpha and MMP-9 suggest that APRV could be as protective for ARDS as LTV with recruitment group.