This document discusses potential advantages of using airway pressure release ventilation (APRV) based on experimental and clinical studies. Key advantages include: 1) APRV with spontaneous breathing can increase recruitment of dependent lung regions and decrease pulmonary shunt; 2) APRV may improve hemodynamics and organ perfusion compared to other ventilation modes; 3) APRV is associated with reduced sedative needs, less neuromuscular blockade, and improved patient and family comfort.

1. Potential Advantages Using Airway Pressure Release Ventilation Lewis J. Kaplan, MD, FACS, FCCM Associate Professor of Surgery Yale University School of Medicine Director, SICU & Surgical Critical Care Program

4. High CPAP Release (T low ) Phase cycle APRV: Pressure and Flow PEEP i T high

6. RUL COLLAPSE: Optimized PEEP, V T , Flow

7. APRV 1 HOUR

8. APRV 3 HOURS

9. WHAT APRV DOESN’T FIX RMSB

10. Which way do we go from here?

11. Spontaneous Breathing

13. Results: Experimental ALI torr cc % (Aeration Indexed to APRV +) * * * Adapted from: Wrigge H, et al. Anesthesiology 2003; 99(2):376-84

14. End Expiratory Lung Volume (N 2 ) Adapted from: Wrigge H, et al. Anesthesiology 2003; 99(2):376-84

16. Basilar Atelectasis

18. Summed Ventilation (ml/min) Sternum Spine

19. Summed Perfusion (ml/min) Sternum Spine

21. Hemodynamics

23. Etiology Of ALI/ARDS PNA Abd sepsis Trauma BSI TRALI TRALI = Transfusion Related Acute Lung Injury Percent Kaplan LJ, et al. Crit Care 2001; 5(4):221-6

24. Paw And Pharmacology Pawpk Paw % NMB % Sedatives pre post pre post pre post pre post # or % * * * Kaplan LJ, et al. Crit Care 2001; 5(4):221-6

25. C.I. % pre-DO 2 I LVSWI CVP pre post pre post pre post pre post Hemodynamics Pre and Post * * * Kaplan LJ, et al. Crit Care 2001; 5(4):221-6 # or %

28. APRV and Renal Blood Flow % cc Indexed Hering R, et al. Int Care Med 2002; 28(10):1426-33 * * * * * *

30. Comfort

33. APRV In The OR