Table 3.
Summary of human trials using F-APRV
| First author | Year | n | Study design | %CPAP | TLow | Findings |
|---|---|---|---|---|---|---|
| Garner [31] | 1988 | 14 | Crossover CPPV baseline with APRV wean |
N/A | 1.5 s | APRV maintained similar oxygenation with >50 % reduced PIP |
| Rasanen [40] | 1991 | 50 | Crossover PEEP titrated CPPV vs. APRV |
50 % | 1.5 s | APRV maintained similar oxygenation with >50 % reduced PIP |
| Cane [28] | 1991 | 18 | Crossover CPPV vs. APRV |
67 % | 1.5 s | APRV maintained similar oxygenation and cardiopulmonary function with reduced PIP |
| Davis [3] | 1993 | 15 | Crossover CPPV vs. APRV |
32 % | 2.6 ± 0.6 | APRV maintained similar oxygenation with >50 % reduced PIP and reduced PEEP |
| Chiang [29] | 1994 | 18 | Crossover CPPV vs. APRV |
66 % | 1.5 s | APRV maintained similar oxygenation with >50 % reduced PIP |
| Sydow [42] | 1994 | 18 | Crossover CPPV vs. APRV |
80 % | 0.5–0.7 | APRV maintained similar oxygenation with decreased A-a gradient after 8 h and reduced PIP |
| Bratzke [27] | 1998 | 20 | Crossover CPPV vs. APRV |
88 % | 1 | APRV maintained similar oxygenation with reduced PIP |
| Kaplan [36] | 2001 | 12 | Crossover Inverse ratio PPV vs. APRV |
85 % | 0.8 | APRV is safe, decreases PIP and need for sedation/paralytics/pressors, increases CI |
| Putensen [39] | 2001 | 30 | Randomized prospective CPPV vs. APRV |
Identical to CPPV | Exp flow 0 | APRV + SB maintained increased oxygenation, CI, and pulmonary compliance with reduced ALI/ARDS incidence and sedative requirements |
| Schultz [41] | 2001 | 15 | Crossover CPPV vs. APRV |
N/A | N/A | APRV maintained similar oxygenation with >50 % reduced PIP |
| Wrigge [45] | 2001 | 14 | Randomized prospective APRV +/− automatic tube compensation |
N/A | N/A | APRV with tube compensation increased end-expiratory lung volume and minute ventilation without affecting oxygenation or cardiopulmonary status |
| Hering [34] | 2002 | 12 | Crossover APRV +/− SB |
N/A | N/A | APRV + SB had increased renal blood flow and glomerular filtration rate |
| Varpula [43] | 2003 | 33 | Randomized prospective CPPV vs. APRV |
N/A | Exp flow 0 | APRV feasible in prone positioning and increased oxygenation at 24 h |
| Varpula [44] | 2004 | 58 | Randomized prospective CPPV vs. APRV |
80 % | 1 | APRV had similar mortality and ventilator free days |
| Dart [30] | 2005 | 46 | Crossover CPPV vs. APRV |
N/A | 40–50 % PEF | APRV reduced PIP and increased oxygenation |
| Liu [37] | 2009 | 58 | Retrospective case-control CPPV vs. APRV |
67 % | ~1.5 | APRV reduced pressor use/A-a gradient and increased oxygenation |
| Kamath [35] | 2010 | 11 | Retrospective cohort CPPV vs. APRV |
70 % | 1.2 ± 0.9 | APRV had no adverse effects on blood pressure or urine output |
| Gonzalez [32] | 2010 | 468 | Case matched retrospective CPPV vs. APRV |
70 % | N/A | APRV maintained similar oxygenation with reduced PIP and associated increased tracheostomy rate |
| Maxwell [38] | 2010 | 63 | Randomized prospective LTV vs. APRV |
N/A | 25–75 % PEF | APRV had similar physiological parameters despite increased disease severity at baseline |
| Hanna [33] | 2011 | 45 | Retrospective case series CPPV vs. APRV |
N/A | N/A | APRV had increased P/F Ratio, lung procurement rate with similar graft survival rate |
| Maung [46] | 2012 | 38 | Retrospective case series APRV |
85 % | 0.8–1 | Switching from CPPV to APRV improved oxygenation and decreased PCO2 without hemodynamic compromise |
| Maung [47] | 2012 | 362 | Retrospective case series CPPV vs. APRV |
N/A | N/A | APRV had increased ventilator days. |
| Testerman [48] | 2013 | 48 | Case-matched retrospective APRV; obese vs. nonobese |
N/A | N/A | APRV in morbidly obese similar to nonobese, though morbidly obese required extended care after discharge more often |
Number of studies: 23
T Low time at low pressure, CPPV conventional positive pressure ventilation, LTV low tidal volume ventilation, CPAP continuous positive airway pressure, PEF peak expiratory flow, SB spontaneous breathing, PEEP positive end-expiratory pressure, PIP peak inspiratory pressure