From the Research
The calculated driving pressure on Airway Pressure Release Ventilation (APRV) with a Phigh of 27 cmH2O, Plow of 0 cmH2O, and Pmean of 23 cmH2O is 27 cmH2O. In APRV, the driving pressure is essentially the difference between the high pressure (Phigh) and the low pressure (Plow), which in this case is 27 - 0 = 27 cmH2O. This represents the pressure gradient that drives air into the lungs during ventilation. The mean airway pressure (Pmean) of 23 cmH2O indicates that the patient is spending more time at the high pressure level than at the low pressure level, which is typical of APRV settings. The driving pressure is an important parameter to monitor as it correlates with the stress applied to the lungs during mechanical ventilation. Higher driving pressures may increase the risk of ventilator-induced lung injury, so clinicians should aim to maintain the lowest driving pressure that provides adequate ventilation and oxygenation, as suggested by a study published in Respiratory research 1. Key points to consider when using APRV include:
- Monitoring the driving pressure to minimize the risk of lung injury
- Adjusting the Phigh and Plow levels to achieve the desired mean airway pressure
- Ensuring that the patient is able to breathe spontaneously during the APRV cycle
- Closely monitoring the patient's oxygenation and ventilation status, as reported in a study published in Critical care medicine 2. It is also important to note that APRV has been shown to improve oxygenation and lung recruitment in patients with Acute Respiratory Distress Syndrome (ARDS), as demonstrated in a study published in Journal of intensive care medicine 3. However, the effectiveness of APRV may vary depending on the specific patient population and clinical context, highlighting the need for careful patient selection and monitoring, as discussed in a study published in Respiratory research 1.