The time-controlled adaptive ventilation protocol: Mechanistic approach to reducing ventilator-induced lung injury
JournalEuropean Respiratory Review
PublisherEuropean Respiratory Society
MetadataShow full item record
AbstractAirway pressure release ventilation (APRV) is a ventilator mode that has previously been considered a rescue mode, but has gained acceptance as a primary mode of ventilation. In clinical series and experimental animal models of extrapulmonary acute respiratory distress syndrome (ARDS), the early application of APRV was able to prevent the development of ARDS. Recent experimental evidence has suggested mechanisms by which APRV, using the time-controlled adaptive ventilation (TCAV) protocol, may reduce lung injury, including: 1) an improvement in alveolar recruitment and homogeneity; 2) reduction in alveolar and alveolar duct micro-strain and stress-risers; 3) reduction in alveolar tidal volumes; and 4) recruitment of the chest wall by combating increased intra-abdominal pressure. This review examines these studies and discusses our current understanding of the pleiotropic mechanisms by which TCAV protects the lung. APRV set according to the TCAV protocol has been misunderstood and this review serves to highlight the various protective physiological and mechanical effects it has on the lung, so that its clinical application may be broadened.
SponsorsFunding was received from the U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute (R01 HL131143).
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85065070751&doi=10.1183%2f16000617.0126-2018&partnerID=40&md5=b9d5af79e4f68d4e7c7f8b90c8e32982; http://hdl.handle.net/10713/10800