RT Journal Article
SR Electronic
T1 The time-controlled adaptive ventilation protocol: mechanistic approach to reducing ventilator-induced lung injury
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 180126
DO 10.1183/16000617.0126-2018
VO 28
IS 152
A1 Kollisch-Singule, Michaela
A1 Andrews, Penny
A1 Satalin, Joshua
A1 Gatto, Louis A.
A1 Nieman, Gary F.
A1 Habashi, Nader M.
YR 2019
UL http://err.ersjournals.com/content/28/152/180126.abstract
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