Airway Pressure Release Ventilation in ARDS Management

Introduction to APRV

The American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine 2017 guidelines make no recommendation for APRV use in ARDS, as it was not included in their evidence-based recommendations 1, 2
The American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine strongly recommends low tidal volume ventilation (4-8 ml/kg predicted body weight) with plateau pressure ≤30 cmH₂O as the standard approach for ARDS management 1, 2

A 2021 meta-analysis of 6 RCTs with 360 ARDS patients showed reduced 28-day mortality (RR 0.66, 95% CI: 0.47-0.94) and lower peak pressures (MD -2.04 cmH₂O) with APRV use 3
However, the evidence quality remains insufficient to change practice due to unclear risk of bias in included studies 3

Before considering APRV, ensure implementation of evidence-based ARDS interventions, including low tidal volume ventilation (4-8 ml/kg PBW) with plateau pressure ≤30 cmH₂O 1, 2, 4
Higher PEEP (10-15 cmH₂O) is recommended for moderate-severe ARDS 1, 2
Prone positioning >12 hours daily is recommended for severe ARDS (PaO₂/FiO₂ <150) 1, 2
Recruitment maneuvers with hemodynamic monitoring are also recommended 4