Airway Pressure Release Ventilation Versus Conventional Ventilation in Adults With or at Risk for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis of Randomized Trials.
Muhammad Sajawal, Rabia Kamal, Syed Muhammad Moizuddin et al.
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In 30 seconds
This systematic review and meta-analysis of randomized trials compared airway pressure release ventilation (APRV) with conventional invasive ventilation in adults with ARDS, acute lung injury, or conditions placing them at high risk of ARDS. Nine trials involving 585 participants showed no demonstrated mortality benefit with APRV (risk ratio 0.95, 95% CI 0.72-1.26). Ventilator-free days and ventilation duration also showed no clear differences. APRV was associated with better oxygenation and shorter ICU stay, but the authors caution that these findings are uncertain amid substantial variation across trials and low to very low certainty evidence.
Key findings
- Across nine trials and 585 participants, APRV did not demonstrate a mortality benefit (risk ratio 0.95, 95% CI 0.72-1.26).
- Ventilator-free days showed no clear difference (mean difference [MD] 3.83 days, 95% CI - 1.69 to 9.34; I²=83%).
- APRV was associated with a higher PaO₂/FiO₂ ratio (MD 56.21 mm Hg, 95% CI 24.63-87.79; I²=84%) and shorter ICU stay (MD - 2.53 days, 95% CI - 4.43 to - 0.64; I²=71%).
- Ventilation duration showed no clear difference (five trials, 413 participants; MD - 2.44 days, 95% CI - 4.96 to 0.09; I²=78%).
Why it matters
The findings distinguish possible improvements in oxygenation and ICU stay from outcomes that matter most for survival and liberation from ventilation. Because the evidence does not establish a survival advantage or equivalence, and certainty is low to very low, the results should be interpreted cautiously rather than as proof that APRV is superior or interchangeable with contemporary lung-protective ventilation.
What to keep in mind
Evidence certainty was low to very low. Populations, ventilation protocols, outcome timing, and risk of bias varied; oxygenation and ICU-stay results also showed substantial heterogeneity.