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