TY - JOUR
T1 - Airway pressure release ventilation versus assist-control ventilation
T2 - A comparative propensity score and international cohort study
AU - González, Marco
AU - Arroliga, Alejandro C.
AU - Frutos-Vivar, Fernando
AU - Raymondos, Konstantinos
AU - Esteban, Andres
AU - Putensen, Christian
AU - Apezteguía, Carlos
AU - Hurtado, Javier
AU - Desmery, Pablo
AU - Tomicic, Vinko
AU - Elizalde, José
AU - Abroug, Fekri
AU - Arabi, Yaseen
AU - Moreno, Rui
AU - Anzueto, Antonio
AU - Ferguson, Niall D.
N1 - Funding Information:
Acknowledgment Dr. Ferguson is supported by a New Investigator Award from the Canadian Institutes of Health Research (Ottawa, Canada).
PY - 2010/5
Y1 - 2010/5
N2 - Purpose: To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality. Methods: Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups. Results: In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital. Conclusions: In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation.
AB - Purpose: To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality. Methods: Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups. Results: In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital. Conclusions: In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation.
KW - Airway pressure release ventilation
KW - Assist-control ventilation
KW - Epidemiology
KW - Mechanical ventilation
KW - Mortality
KW - Propensity score
UR - http://www.scopus.com/inward/record.url?scp=77951204674&partnerID=8YFLogxK
U2 - 10.1007/s00134-010-1837-1
DO - 10.1007/s00134-010-1837-1
M3 - Artículo en revista científica indexada
C2 - 20229042
AN - SCOPUS:77951204674
SN - 0342-4642
VL - 36
SP - 817
EP - 827
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 5
ER -