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Intensive Care Medicine

, Volume 36, Issue 5, pp 817–827 | Cite as

Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study

  • Marco González
  • Alejandro C. Arroliga
  • Fernando Frutos-Vivar
  • Konstantinos Raymondos
  • Andres EstebanEmail author
  • Christian Putensen
  • Carlos Apezteguía
  • Javier Hurtado
  • Pablo Desmery
  • Vinko Tomicic
  • José Elizalde
  • Fekri Abroug
  • Yaseen Arabi
  • Rui Moreno
  • Antonio Anzueto
  • Niall D. Ferguson
Original

Abstract

Purpose

To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality.

Methods

Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups.

Results

In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital.

Conclusions

In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation.

Keywords

Mechanical ventilation Airway pressure release ventilation Assist-control ventilation Mortality Epidemiology Propensity score 

Notes

Acknowledgment

Dr. Ferguson is supported by a New Investigator Award from the Canadian Institutes of Health Research (Ottawa, Canada).

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Marco González
    • 1
  • Alejandro C. Arroliga
    • 2
  • Fernando Frutos-Vivar
    • 3
    • 4
  • Konstantinos Raymondos
    • 5
  • Andres Esteban
    • 3
    • 4
    Email author
  • Christian Putensen
    • 6
  • Carlos Apezteguía
    • 7
  • Javier Hurtado
    • 8
  • Pablo Desmery
    • 9
  • Vinko Tomicic
    • 10
  • José Elizalde
    • 11
  • Fekri Abroug
    • 12
  • Yaseen Arabi
    • 13
  • Rui Moreno
    • 14
  • Antonio Anzueto
    • 15
  • Niall D. Ferguson
    • 16
  1. 1.Clínica Medellín y Universidad Pontificia BolivarianaMedellínColombia
  2. 2.Scott and White, and Texas A&M Health Science Center, College of MedicineTempleUSA
  3. 3.Intensive Care UnitHospital Universitario de GetafeMadridSpain
  4. 4.CIBER Enfermedades RespiratoriasMadridSpain
  5. 5.Medizinische HochschuleHannoverGermany
  6. 6.Department of Anesthesiology and Intensive Care MedicineUniversity of BonnBonnGermany
  7. 7.Hospital Profesor A. Posadas, El PalomarBuenos AiresArgentina
  8. 8.Hospital de ClínicasMontevideoUruguay
  9. 9.Sanatorio MitreBuenos AiresArgentina
  10. 10.Clínica Alemana de SantiagoSantiagoChile
  11. 11.Hospital ABCMexico DFMexico
  12. 12.Fattouma Bourguiba MonastirMonastirTunisia
  13. 13.King Abdulaziz Medical CityRiyadhSaudi Arabia
  14. 14.Hospital de Santo António dos CapuchosLisbonPortugal
  15. 15.South Texas Veterans Health Care System and University of Texas Health Science CenterSan AntonioUSA
  16. 16.Interdepartmental Division of Critical Care Medicine, Division of Respirology, Department of MedicineUniversity Health Network and Mount Sinai Hospital, University of TorontoTorontoCanada

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