Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring
Abstract Background APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in r...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-02-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-025-02904-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832571372333694976 |
|---|---|
| author | Sandra Emily Stoll Tobias Leupold Hendrik Drinhaus Fabian Dusse Bernd W. Böttiger Alexander Mathes |
| author_facet | Sandra Emily Stoll Tobias Leupold Hendrik Drinhaus Fabian Dusse Bernd W. Böttiger Alexander Mathes |
| author_sort | Sandra Emily Stoll |
| collection | DOAJ |
| description | Abstract Background APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings. Methods This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes. Results 20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR − 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO2- removal between both modes. Conclusion Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS. |
| format | Article |
| id | doaj-art-54e4d50c6a5c49ec8398ad7f9b7d119a |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-54e4d50c6a5c49ec8398ad7f9b7d119a2025-02-02T12:39:58ZengBMCBMC Anesthesiology1471-22532025-02-012511910.1186/s12871-025-02904-7Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoringSandra Emily Stoll0Tobias Leupold1Hendrik Drinhaus2Fabian Dusse3Bernd W. Böttiger4Alexander Mathes5Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of CologneAbstract Background APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings. Methods This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes. Results 20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR − 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO2- removal between both modes. Conclusion Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.https://doi.org/10.1186/s12871-025-02904-7Transpulmonary pressureCOVIDARDSSARS CoV-2CARDSAtelectrauma |
| spellingShingle | Sandra Emily Stoll Tobias Leupold Hendrik Drinhaus Fabian Dusse Bernd W. Böttiger Alexander Mathes 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 Transpulmonary pressure COVID ARDS SARS CoV-2 CARDS Atelectrauma |
| title | Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring |
| title_full | Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring |
| title_fullStr | Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring |
| title_full_unstemmed | Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring |
| title_short | Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring |
| title_sort | comparison of airway pressure release ventilation aprv versus biphasic positive airway pressure bipap ventilation in covid 19 associated ards using transpulmonary pressure monitoring |
| topic | Transpulmonary pressure COVID ARDS SARS CoV-2 CARDS Atelectrauma |
| url | https://doi.org/10.1186/s12871-025-02904-7 |
| work_keys_str_mv | AT sandraemilystoll comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring AT tobiasleupold comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring AT hendrikdrinhaus comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring AT fabiandusse comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring AT berndwbottiger comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring AT alexandermathes comparisonofairwaypressurereleaseventilationaprvversusbiphasicpositiveairwaypressurebipapventilationincovid19associatedardsusingtranspulmonarypressuremonitoring |