The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

THE UTILIZATION OF AIRWAY PRESSURE RELEASE VENTILATION AS A RECRUITMENT STRATEGY FOR PATIENTS WHO DEVELOP ATELECTASIS

K. Miller1, D. Schaff1, L. Cornman1


Introduction:
Patients who are admitted to a trauma unit often require multiple surgical procedures during their clinical course. During the introduction of general anesthesia there is risk that alveolar decruitment can take place for various reasons. Airway Pressure Release Ventilation (APRV) is a ventilatory strategy that incorporates a long inspiratory time with a moderate airway pressure along with a short expiratory burst. APRV has been studied in several diverse patient populations including its use in the obese patient, acute lung injury, and other forms of lung decompensation. We wished to examine the use of APRV in patients who developed respiratory decompensation during an operative procedure.

Methods: Retrospectively, we reviewed ten patients that were admitted into our trauma/surgical ICU over a twelve month time span. The patients that were evaluated demonstrated lung decompensation during an operative period greater than two hours. The treatment postoperatively was APRV as a ventilatory strategy to improve oxygenation. Improved oxygenation was noted by an increase of PaO2/FIO2 ratio (P/F ratio) by twenty-five percent. All patients were placed on APRV within fours hours post operative procedure.
Results:

Conclusions: APRV significantly increased the PF ratio in ten patients whose PF ratio dropped by more than twenty percent post-operatively (p .008) We did not examine this improvement in PF ratio on mortality or morbility or its impact on ventilator duration.
More clinical studies need to be conducted on APRV role in the surgical and trauma patient populations.

PF Ratio Post APRV
Patient Pre PF Post PF PF Post 4 hours
1 345 185 257
2 321 222 346
3 400 285 435
4 355 227 367
5 280 180 320
6 250 200 310
7 450 180 350
8 290 155 225
9 400 210 339
10 450 166 280



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