A Pilot Study of Patients With COVID–19-Related Respiratory Failure Utilizing Airway Pressure Release Ventilation (APRV)

Abstract

Background: Pneumonia leading to acute respiratory distress syndrome (ARDS) is one of the devastating consequences of coronavirus disease 2019 (COVID-19). Airway pressure release ventilation (APRV) has been described as beneficial in acute lung injury and ARDS. We hypothesized that utilizing APRV would be advantageous in the COVID-19 ARDS population. Methods: Prospective, observational, single-center study. Data were extracted on demographics, vasopressors, sedatives, analgesics, and oxygenation (PaO2/FiO2). A generalized linear mixed models analysis was performed to compare low tidal volume ventilation (LTV) with APRV for patients who required intubation due to ARDS from COVID-19 and who were managed with at least 48 consecutive hours of APRV in our surgical intensive care unit (SICU). Results: Twelve patients met criteria; two were on APRV mode from admission to the SICU and were not included in the study. Ten patients were analyzed and were primarily male (70%), average age of 64.5 6 12.9 years, and 70% were obese (average body mass index of 30.6 6 8.0 kg/m 2). There were no smokers in the sample, but two patients presented with underlying lung pathology. APRV was shown to significantly increase the PaO 2 /FiO 2 ratio by 30% (5% to 61%) (p ¼ 0.05) and was associated with up to a 12% (À26% to 5%) reduction in the level of F i O 2 and reduction in the use of vasopressor support (À59% [À83% to À2%]), sedatives (À15% [À29% to 2%]), and analgesics (À16% [À38% to 12%]). Conclusions: This pilot study showed that APRV was associated with decreases in FiO 2 , vasopressors, sedatives, and analgesic requirements with an increase in PaO 2 /FiO 2 ratio. In the current pandemic, where providers are grappling with ways to manage COVID-19 ARDS, APRV may be the optimal ventilator mode. Prospective randomized studies are required to validate whether use of APRV in the COVID-19 population leads to improved oxygenation and a subsequent decrease of ventilator days and length of stay.