368:), was introduced in Europe. The term APRV has also been used in American journals where, from the ventilation characteristics, BIPAP would have been the appropriate terminology. To further confusion, BiPAP is a registered trade-mark for a noninvasive ventilation mode in a specific ventilator (Respironics Inc.). Other names (BILEVEL, DUOPAP, BIVENT) have been created for legal reasons. Although similar in modality, these terms describe how a mode is intended to inflate the lung, rather than defining the characteristics of synchronization or the way spontaneous breathing efforts are supported. Concern has been raised about the amount of mechanical power applied to the lung during APRV and the risk of ergotrauma, especially in pulmonary ARDS.
58:
67:
124:
20:
79:(CPAP) with an intermittent release phase. APRV begins at a pressure higher than the baseline pressure and follows with a deflation to accomplish tidal ventilation. Fundamentally APRV is a time-cycled alternant between two levels of positive airway pressure, with the main time on the high level and a brief expiratory release to facilitate ventilation.
70:
Corresponding pressure and flow curves during one cycle of inflationdeflation. Notice the flow curve goes back to zero at the end of inflation, indicating full lung inflation; and also goes back to zero during the release period before inflation starts, indicating complete gas exhalation with no
858:
Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA (1994). "Long-term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume-controlled inverse ratio ventilation".
49:(CPAP) that at a set timed interval releases the applied pressure. Depending on the ventilator manufacturer, it may be referred to as BiVent. This is just as appropriate to use, since the only difference is that the term APRV is copyrighted.
115:) is shortened to usually less than one second to maintain alveoli inflation. Fundamentally this is a continuous pressure with a brief release. APRV is currently the most efficient, conventional mode for lung protective ventilation.
636:
Hering R, Zinserling J, Wrigge H, Varelmann D, Berg A, Kreyer S, et al. (2005). "Effects of spontaneous breathing during airway pressure release ventilation on respiratory work and muscle blood flow in experimental lung injury".
127:
Pressure-time curve for APRV. 'P high' is the high CPAP, 'P low' is the low CPAP, 'T high' is the duration of 'P high,' and 'T low' is the release period or the duration of 'P low.' Spontaneous breathing appears on the top of 'P
346:
132:
Settings are sometimes brand specific and the term for the individual settings may differ, however generally the settings listed here are a fundamental explanation of the purpose of the settings within the APRV mode.
724:
Putensen C, Mutz NJ, Putensen-Himmer G, Zinserling J (1999). "Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome".
61:
Static pressure-volume curve during volume-controlled mechanical ventilation. High pressure ('P high') is set below the high inflection point (HIP) and low pressure is set above the low inflection point
1016:
894:
RΓ€sΓ€nen J, Cane RD, Downs JB, Hurst JM, Jousela IT, Kirby RR, et al. (1991). "Airway pressure release ventilation during acute lung injury: a prospective multicenter trial".
1271:
1155:
196:
376:
APRV is used by many brands and models of mechanical ventilators under different names. Most names are copyrighted as trademarks and do not represent
57:
1518:
1220:
1188:
377:
1183:
1148:
765:"Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome"
1287:
1241:
1053:"Cardiorespiratory effects of automatic tube compensation during airway pressure release ventilation in patients with acute lung injury"
92:
76:
46:
66:
1261:
1256:
1225:
1210:
1206:
1327:
1343:
1215:
896:
510:
473:
365:
1317:
1198:
1178:
1141:
38:
1014:(July 2001). "Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury".
1375:
1251:
123:
1492:
1266:
1367:
108:
42:
19:
1404:
1235:
1230:
589:
87:
Based on clinical and experimental data, airway pressure release ventilation is indicated in patients with
1164:
1463:
823:
471:
Downs JB, Stock MC (1987). "Airway pressure release ventilation: a new concept in ventilatory support".
960:
580:
1523:
1383:
1307:
1302:
818:
814:
183:
1007:
958:(September 1989). "Biphasic positive airway pressure (BIPAP)--a new form of augmented ventilation".
999:
360:
Different perceptions of this mode may exist around the globe. While 'APRV' is common to users in
1447:
1420:
1123:
1098:
Daoud EG, Farag HL, Chatburn RL (2012). "Airway pressure release ventilation: what do we know?".
1082:
987:
947:
921:
703:
1051:
Wrigge H, Zinserling J, Hering R, Schwalfenberg N, StΓΌber F, von
Spiegel T, et al. (2001).
1003:
995:
951:
943:
1487:
1455:
1115:
1074:
1033:
969:
913:
876:
840:
796:
742:
695:
654:
618:
562:
527:
490:
453:
390:
BiLevel - (Puritan
Bennett 840 ventilator by Covidien, Flight-60 ventilator by Flight Medical)
88:
1011:
991:
955:
939:
545:
Frawley, PM; Habashi, NM (2001). "Airway pressure release ventilation: Theory and practice".
1497:
1428:
1391:
1107:
1064:
1025:
905:
868:
832:
786:
776:
734:
685:
646:
608:
598:
554:
519:
482:
443:
433:
75:
Airway pressure release ventilation was described initially by Stock and Downs in 1987 as a
35:
821:(July 2011). "Airway pressure release ventilation in acute respiratory distress syndrome".
672:
Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, et al. (2003).
1322:
1292:
613:
584:
448:
421:
1512:
1069:
1052:
909:
791:
764:
690:
673:
558:
523:
486:
361:
1127:
707:
1412:
1086:
925:
341:{\displaystyle {\frac {(P_{high}*T_{high})\,+(P_{low}*T_{low})}{T_{high}+T_{low}}}}
1029:
872:
738:
674:"Spontaneous breathing improves lung aeration in oleic acid-induced lung injury"
508:
Stock MC, Downs JB, Frolicher DA (1987). "Airway pressure release ventilation".
96:
1312:
836:
650:
1297:
438:
1119:
1111:
1078:
1037:
844:
800:
746:
699:
658:
622:
566:
457:
973:
917:
880:
531:
494:
1133:
1359:
174:β The fractional O2 percentage of the delivered air-and-oxygen mixture.
781:
603:
143:β This is the inspiratory pressure (just like in pressure control).
1475:
152:β This value is the number of seconds during the inhalation phase.
122:
65:
56:
18:
1351:
1137:
1017:
American
Journal of Respiratory and Critical Care Medicine
364:, a very similar mode, biphasic positive airway pressure (
380:
but may be referred to clinically by the brand name.
199:
1440:
1403:
1336:
1280:
1197:
1171:
340:
16:Pressure control mode of mechanical ventilation
758:
756:
719:
717:
415:
413:
411:
409:
407:
1149:
8:
165:, this is the time allotted for expiration.
1156:
1142:
1134:
1068:
790:
780:
689:
612:
602:
447:
437:
323:
301:
280:
261:
250:
232:
210:
200:
198:
763:Kaplan LJ, Bailey H, Formosa V (2001).
403:
387:BiVent - (Servo-i ventilator by Maquet)
186:on APRV is calculated by this formula:
1189:Nomenclature of mechanical ventilation
393:DuoPAP - ( C-1 ventilator by Hamilton)
378:nomenclature of mechanical ventilation
1184:Mechanical ventilation in emergencies
422:"Airway pressure release ventilation"
7:
93:acute respiratory distress syndrome
77:continuous positive airway pressure
47:continuous positive airway pressure
28:Airway pressure release ventilation
14:
1328:Ventilator-associated lung injury
1070:10.1097/00000542-200108000-00020
910:10.1097/00003246-199110000-00004
691:10.1097/00000542-200308000-00019
559:10.1097/00044067-200105000-00007
524:10.1097/00003246-198705000-00002
487:10.1097/00003246-198705000-00001
1519:Modes of mechanical ventilation
1318:Ventilator-associated pneumonia
1179:Modes of mechanical ventilation
292:
254:
247:
203:
45:strategy. APRV is an applied
39:mode of mechanical ventilation
1:
383:Some of these names include:
1030:10.1164/ajrccm.164.1.2001078
873:10.1164/ajrccm.149.6.8004312
739:10.1164/ajrccm.159.4.9806077
1540:
356:Perceptions and receptions
1272:List of modes by category
861:Am J Respir Crit Care Med
837:10.1016/j.ccc.2011.05.003
727:Am J Respir Crit Care Med
119:Settings and measurements
109:inverse ratio ventilation
103:Inverse ratio ventilation
43:inverse ratio ventilation
651:10.1378/chest.128.4.2991
585:"What on earth is APRV?"
111:. The exhalation time (T
439:10.4103/1817-1737.36556
23:A pressure-time graphic
1165:Mechanical ventilation
1112:10.4187/respcare.01238
897:Critical Care Medicine
511:Critical Care Medicine
474:Critical Care Medicine
342:
129:
72:
63:
24:
824:Critical Care Clinics
343:
161:β Also known as the T
126:
69:
60:
22:
1308:Pulmonary volutrauma
1303:Pulmonary barotrauma
197:
184:Mean airway pressure
179:Mean airway pressure
99:after major surgery
733:(4 Pt 1): 1241β8.
338:
130:
107:This is a type of
73:
64:
25:
1506:
1505:
420:Daoud EG (2007).
336:
89:acute lung injury
41:that utilizes an
1531:
1498:Mechanical power
1158:
1151:
1144:
1135:
1131:
1091:
1090:
1072:
1048:
1042:
1041:
984:
978:
977:
961:Der Anaesthesist
936:
930:
929:
891:
885:
884:
855:
849:
848:
811:
805:
804:
794:
784:
760:
751:
750:
721:
712:
711:
693:
669:
663:
662:
633:
627:
626:
616:
606:
581:Dietrich Henzler
577:
571:
570:
547:AACN Clin Issues
542:
536:
535:
505:
499:
498:
468:
462:
461:
451:
441:
417:
347:
345:
344:
339:
337:
335:
334:
333:
315:
314:
295:
291:
290:
272:
271:
246:
245:
224:
223:
201:
36:pressure control
1539:
1538:
1534:
1533:
1532:
1530:
1529:
1528:
1509:
1508:
1507:
1502:
1483:
1479:
1471:
1467:
1459:
1451:
1436:
1432:
1424:
1416:
1399:
1395:
1387:
1379:
1371:
1363:
1355:
1347:
1332:
1323:Oxygen toxicity
1281:Related illness
1276:
1193:
1167:
1162:
1097:
1095:
1094:
1050:
1049:
1045:
986:
985:
981:
938:
937:
933:
904:(10): 1234β41.
893:
892:
888:
857:
856:
852:
819:Lewis J. Kaplan
815:Adrian A. Maung
813:
812:
808:
762:
761:
754:
723:
722:
715:
671:
670:
666:
635:
634:
630:
579:
578:
574:
544:
543:
539:
507:
506:
502:
470:
469:
465:
419:
418:
405:
400:
374:
358:
319:
297:
296:
276:
257:
228:
206:
202:
195:
194:
181:
172:
164:
159:
150:
141:
121:
114:
105:
85:
71:intrinsic PEEP.
55:
17:
12:
11:
5:
1537:
1535:
1527:
1526:
1521:
1511:
1510:
1504:
1503:
1501:
1500:
1495:
1490:
1485:
1481:
1477:
1473:
1469:
1465:
1461:
1457:
1453:
1449:
1444:
1442:
1438:
1437:
1435:
1434:
1430:
1426:
1422:
1418:
1414:
1409:
1407:
1401:
1400:
1398:
1397:
1393:
1389:
1385:
1381:
1377:
1373:
1369:
1365:
1361:
1357:
1353:
1349:
1345:
1340:
1338:
1334:
1333:
1331:
1330:
1325:
1320:
1315:
1310:
1305:
1300:
1295:
1293:Atelectotrauma
1290:
1284:
1282:
1278:
1277:
1275:
1274:
1269:
1264:
1259:
1254:
1249:
1244:
1239:
1233:
1228:
1223:
1218:
1213:
1203:
1201:
1195:
1194:
1192:
1191:
1186:
1181:
1175:
1173:
1169:
1168:
1163:
1161:
1160:
1153:
1146:
1138:
1093:
1092:
1057:Anesthesiology
1043:
1008:T. Von Spiegel
979:
968:(9): 452β458.
931:
886:
850:
831:(3): 501β509.
806:
782:10.1186/cc1027
752:
713:
678:Anesthesiology
664:
628:
604:10.1186/cc9419
572:
537:
500:
463:
426:Ann Thorac Med
402:
401:
399:
396:
395:
394:
391:
388:
373:
370:
357:
354:
353:
352:
351:
350:
349:
348:
332:
329:
326:
322:
318:
313:
310:
307:
304:
300:
294:
289:
286:
283:
279:
275:
270:
267:
264:
260:
256:
253:
249:
244:
241:
238:
235:
231:
227:
222:
219:
216:
213:
209:
205:
180:
177:
176:
175:
170:
166:
162:
157:
153:
148:
144:
139:
120:
117:
112:
104:
101:
84:
81:
54:
51:
15:
13:
10:
9:
6:
4:
3:
2:
1536:
1525:
1522:
1520:
1517:
1516:
1514:
1499:
1496:
1494:
1491:
1489:
1486:
1484:
1474:
1472:
1462:
1460:
1454:
1452:
1446:
1445:
1443:
1439:
1433:
1427:
1425:
1419:
1417:
1411:
1410:
1408:
1406:
1402:
1396:
1390:
1388:
1382:
1380:
1374:
1372:
1366:
1364:
1358:
1356:
1350:
1348:
1342:
1341:
1339:
1335:
1329:
1326:
1324:
1321:
1319:
1316:
1314:
1311:
1309:
1306:
1304:
1301:
1299:
1296:
1294:
1291:
1289:
1286:
1285:
1283:
1279:
1273:
1270:
1268:
1265:
1263:
1260:
1258:
1255:
1253:
1250:
1248:
1245:
1243:
1240:
1237:
1234:
1232:
1229:
1227:
1224:
1222:
1219:
1217:
1214:
1212:
1208:
1205:
1204:
1202:
1200:
1196:
1190:
1187:
1185:
1182:
1180:
1177:
1176:
1174:
1170:
1166:
1159:
1154:
1152:
1147:
1145:
1140:
1139:
1136:
1132:
1129:
1125:
1121:
1117:
1113:
1109:
1106:(2): 282β92.
1105:
1101:
1088:
1084:
1080:
1076:
1071:
1066:
1062:
1058:
1054:
1047:
1044:
1039:
1035:
1031:
1027:
1023:
1019:
1018:
1013:
1009:
1005:
1001:
1000:J. Zinserling
997:
993:
989:
983:
980:
975:
971:
967:
963:
962:
957:
953:
949:
945:
941:
935:
932:
927:
923:
919:
915:
911:
907:
903:
899:
898:
890:
887:
882:
878:
874:
870:
867:(6): 1550β6.
866:
862:
854:
851:
846:
842:
838:
834:
830:
826:
825:
820:
816:
810:
807:
802:
798:
793:
788:
783:
778:
774:
770:
766:
759:
757:
753:
748:
744:
740:
736:
732:
728:
720:
718:
714:
709:
705:
701:
697:
692:
687:
684:(2): 376β84.
683:
679:
675:
668:
665:
660:
656:
652:
648:
645:(4): 2991β8.
644:
640:
632:
629:
624:
620:
615:
610:
605:
600:
596:
592:
591:
590:Critical Care
586:
582:
576:
573:
568:
564:
560:
556:
553:(2): 234β46.
552:
548:
541:
538:
533:
529:
525:
521:
517:
513:
512:
504:
501:
496:
492:
488:
484:
481:(5): 459β61.
480:
476:
475:
467:
464:
459:
455:
450:
445:
440:
435:
431:
427:
423:
416:
414:
412:
410:
408:
404:
397:
392:
389:
386:
385:
384:
381:
379:
371:
369:
367:
363:
362:North America
355:
330:
327:
324:
320:
316:
311:
308:
305:
302:
298:
287:
284:
281:
277:
273:
268:
265:
262:
258:
251:
242:
239:
236:
233:
229:
225:
220:
217:
214:
211:
207:
193:
192:
191:
190:
189:
188:
187:
185:
178:
173:
167:
160:
154:
151:
145:
142:
136:
135:
134:
125:
118:
116:
110:
102:
100:
98:
94:
90:
82:
80:
78:
68:
59:
52:
50:
48:
44:
40:
37:
33:
29:
21:
1493:A-a gradient
1246:
1172:Fundamentals
1103:
1099:
1096:
1063:(2): 382β9.
1060:
1056:
1046:
1024:(1): 43β49.
1021:
1015:
982:
965:
959:
934:
901:
895:
889:
864:
860:
853:
828:
822:
809:
775:(4): 221β6.
772:
768:
730:
726:
681:
677:
667:
642:
638:
631:
594:
588:
575:
550:
546:
540:
518:(5): 462β6.
515:
509:
503:
478:
472:
466:
432:(4): 176β9.
429:
425:
382:
375:
359:
182:
168:
155:
146:
137:
131:
106:
86:
74:
31:
27:
26:
1524:Pulmonology
1100:Respir Care
988:C. Putensen
948:C. Putensen
372:Other terms
97:atelectasis
83:Indications
1513:Categories
1313:Rheotrauma
597:(1): 115.
398:References
1298:Biotrauma
1004:F. Stuber
996:H. Wrigge
952:W. Koller
944:H. Benzer
769:Crit Care
274:∗
226:∗
1337:Pressure
1128:16294092
1120:21762559
1079:11506110
1038:11435237
845:21742214
801:11511336
747:10194172
708:11429381
700:12883410
659:16236977
623:21345265
583:(2011).
567:11759551
458:19727373
1405:Volumes
1087:4679990
1012:N. Mutz
992:S. Zech
974:2686487
956:G. Putz
940:M. Baum
926:3175012
918:1914479
881:8004312
614:3222047
532:3552443
495:3568710
449:2732103
53:History
34:) is a
1458:static
1126:
1118:
1085:
1077:
1036:
972:
924:
916:
879:
843:
817:&
799:
789:
745:
706:
698:
657:
621:
611:
565:
530:
493:
456:
446:
128:high.'
62:(LIP).
1441:Other
1199:Modes
1124:S2CID
1083:S2CID
922:S2CID
792:37408
704:S2CID
639:Chest
366:BIPAP
1394:plat
1288:ARDS
1247:APRV
1242:CPAP
1238:/NIV
1236:BPAP
1211:SIMV
1116:PMID
1075:PMID
1034:PMID
970:PMID
914:PMID
877:PMID
841:PMID
797:PMID
743:PMID
696:PMID
655:PMID
619:PMID
563:PMID
528:PMID
491:PMID
454:PMID
158:peep
149:high
140:high
95:and
32:APRV
1450:dyn
1352:FiO
1346:EEP
1267:HFV
1262:ASV
1257:PAV
1252:MMV
1231:PAP
1226:CSV
1221:ACV
1216:CMV
1207:IMV
1108:doi
1065:doi
1026:doi
1022:164
906:doi
869:doi
865:149
833:doi
787:PMC
777:doi
735:doi
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