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Airway Pressure Release Ventilation

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Mechanical Ventilation in Critically Ill Cancer Patients

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Abstract

Airway pressure release ventilation (APRV) was first described in 1987 by Stock and Downs [1]. It became available on commercial ventilators in the 1990s, and depending upon the brand, it may have any of the following names: APRV (Drager), BiLevel (Covidien), Bi-Vent (Maquet), Biphasic (CareFusion), and DuoPAP (Hamilton). APRV is based on the “open lung concept” and is a form of pressure-controlled intermittent mandatory ventilation using extreme inverse inspiratory–expiratory (I:E) ratios [1]. It can be most easily understood as a type of continuous positive airway pressure (CPAP) mode modified to apply two alternating levels of pressure. The majority of the respiratory cycle (T high) is spent at a high pressure (P high) to maximize alveolar recruitment, while a short period (T low) is spent at a low pressure (P low) to allow CO2 clearance. Mandatory breaths are time-triggered, pressure-targeted, and time-cycled. The patient may breathe at any time during the respiratory cycle, though due to the extreme I:E time ratio, most spontaneous breathing takes place during T high (Fig. 19.1).

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Acknowledgments

No financial or other potential conflicts of interest exist for the authors.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue C-1179, New York, NY, 10065, USA

    Jennifer C. Cabot M.D.

  2. Professor of Medicine and Anesthesiology, Weill Cornell Medical College, New York, NY, USA

    Stephen M. Pastores MD, FACP, FCCP, FCCM

Authors
  1. Jennifer C. Cabot M.D.
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  2. Stephen M. Pastores MD, FACP, FCCP, FCCM
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Corresponding author

Correspondence to Stephen M. Pastores MD, FACP, FCCP, FCCM .

Editor information

Editors and Affiliations

  1. Intensive Care and Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain

    Antonio M. Esquinas

  2. Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    S. Egbert Pravinkumar

  3. Wayne State University School of Medicine, Detroit, Michigan, USA

    AYMAN O. SOUBANI

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Cabot, J.C., Pastores, S.M. (2018). Airway Pressure Release Ventilation. In: Esquinas, A., Pravinkumar, S., SOUBANI, A. (eds) Mechanical Ventilation in Critically Ill Cancer Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-49256-8_19

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  • DOI: https://doi.org/10.1007/978-3-319-49256-8_19

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