BACKGROUND: To recruit poorly ventilated lung areas by providing active and adequate oxygenation is a core aspect of treating patients with acute respiratory distress syndrome (ARDS). The airway pressure release ventilation (APRV) mode is increasingly accepted as a means of supporting patients with ARDS. This study aimed to determine whether the APRV mode is effective in improving oxygenation, compared to conventional ventilation, in adult ARDS patients.
METHODS: We conducted the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for clinical trials in PubMed, Embase, Web of Science, and the Cochrane Library until April 2019. We included all studies comparing APRV and other conventional mechanical ventilation modes for adult ARDS patients. Our primary outcome was oxygenation status (defined as the day 3 PaO₂/FiO₂ ratio). The secondary outcomes were the length of stay (LOS) in the intensive care unit (ICU) and mortality. Sensitivity analyses were performed including studies with conventional low-tidal volume ventilation as a comparator ventilation strategy.
RESULTS: We included six clinical trials enrolling a total of 375 patients. The day 3 PaO₂/FiO₂ was reported in all the studies, and it was significantly higher in patients receiving APRV (mean difference [MD] 51.9 mmHg, 95% confidence intervals (CI) 8.2–95.5, P = 0.02, I² = 92%). There was no significant difference in mortality between APRV and the other conventional ventilator modes (risk difference 0.07, 95% CI: −0.01–0.15, P = 0.08, I² 0%). The point estimate for the effect of APRV on the LOS in ICU indicated a significant reduction in the ICU LOS for the APRV group compared to the counter group (MD 3.1 days, 95% CI 0.4–5.9, P = 0.02, I² = 53%).
CONCLUSION: In this study, using the APRV mode may improve oxygenation on day 3 and contribute to reducing the LOS in ICU. However, it is difficult to draw a clinical message about APRV, and well-designed clinical trials are required to investigate this issue.


中文翻译：

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气道压力释放通气对急性呼吸窘迫综合征成人患者的疗效：临床试验的荟萃分析


背景：通过提供积极和充足的氧合来恢复通气不良的肺部区域是治疗急性呼吸窘迫综合征（ARDS）患者的核心方面。气道压力释放通气 (APRV) 模式越来越多地被接受为支持 ARDS 患者的一种手段。本研究旨在确定与传统通气相比，APRV 模式是否能有效改善成人 ARDS 患者的氧合。
方法：我们根据系统评价和荟萃分析指南的首选报告项目进行了研究。我们在 PubMed、Embase、Web of Science 和 Cochrane 图书馆中检索了截至 2019 年 4 月的临床试验。我们纳入了针对成人 ARDS 患者比较 APRV 和其他传统机械通气模式的所有研究。我们的主要结果是氧合状态（定义为第 3 天 PaO ₂ /FiO ₂比率）。次要结局是重症监护病房（ICU）的住院时间（LOS）和死亡率。进行了敏感性分析，包括以传统低潮气量通气作为比较通气策略的研究。
结果：我们纳入了六项临床试验，总共招募了 375 名患者。所有研究均报告了第 3 天的 PaO ₂ /FiO ₂，接受 APRV 的患者显着较高（平均差 [MD] 51.9 mmHg，95% 置信区间 (CI) 8.2–95.5，P = 0.02，I ² = 92%）。APRV 与其他常规呼吸机模式之间的死亡率没有显着差异（风险差异 0.07，95% CI：-0.01–0.15，P = 0.08，I ² 0%）。APRV 对 ICU LOS 影响的点估计表明，与对照组相比，APRV 组的 ICU LOS 显着降低（MD 3.1 天，95% CI 0.4–5.9，P = 0.02，I ² = 53 %）。
结论：在本研究中，使用 APRV 模式可能会改善第 3 天的氧合，并有助于减少 ICU 的 LOS。然而，很难得出有关 APRV 的临床信息，需要精心设计的临床试验来研究这个问题。