PT  - JOURNAL ARTICLE
AU  - Michaela Kollisch-Singule
AU  - Penny Andrews
AU  - Joshua Satalin
AU  - Louis A. Gatto
AU  - Gary F. Nieman
AU  - Nader M. Habashi
TI  - The time-controlled adaptive ventilation protocol: mechanistic approach to reducing ventilator-induced lung injury
AID  - 10.1183/16000617.0126-2018
DP  - 2019 Jun 30
TA  - European Respiratory Review
PG  - 180126
VI  - 28
IP  - 152
4099  - http://err.ersjournals.com/content/28/152/180126.short
4100  - http://err.ersjournals.com/content/28/152/180126.full
SO  - EUROPEAN RESPIRATORY REVIEW2019 Jun 30; 28
AB  - Airway pressure release ventilation (APRV) is a ventilator mode that has previously been considered a rescue mode, but has gained acceptance as a primary mode of ventilation. In clinical series and experimental animal models of extrapulmonary acute respiratory distress syndrome (ARDS), the early application of APRV was able to prevent the development of ARDS. Recent experimental evidence has suggested mechanisms by which APRV, using the time-controlled adaptive ventilation (TCAV) protocol, may reduce lung injury, including: 1) an improvement in alveolar recruitment and homogeneity; 2) reduction in alveolar and alveolar duct micro-strain and stress-risers; 3) reduction in alveolar tidal volumes; and 4) recruitment of the chest wall by combating increased intra-abdominal pressure. This review examines these studies and discusses our current understanding of the pleiotropic mechanisms by which TCAV protects the lung. APRV set according to the TCAV protocol has been misunderstood and this review serves to highlight the various protective physiological and mechanical effects it has on the lung, so that its clinical application may be broadened.Randomised controlled trials are needed to test the efficacy of the TCAV protocol further; however, experimental evidence demonstrates that TCAV may be effective in preventing VILI and ARDS by a pleiotropy of mechanisms http://ow.ly/uT8J30nSGeN