Universität zu Köln

Stoll, Sandra Emily ORCID: 0000-0002-4803-1362, Leupold, Tobias ORCID: 0009-0006-6048-5419, Drinhaus, Hendrik ORCID: 0000-0001-8435-2246, Dusse, Fabian ORCID: 0000-0001-7762-6966, Böttiger, Bernd W. ORCID: 0000-0001-8000-8931 and Mathes, Alexander ORCID: 0000-0002-0231-0681 (2025). Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring. BMC Anesthesiology, 25 (1). pp. 1-9. BioMed Centra. ISSN 1471-2253

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Abstract

Background: APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings. Methods: This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes. Results: 20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR − 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO 2 - removal between both modes. Conclusion: Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspirator y was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Stoll, Sandra Emily UNSPECIFIED https://orcid.org/0000-0002-4803-1362 UNSPECIFIED Leupold, Tobias UNSPECIFIED https://orcid.org/0009-0006-6048-5419 UNSPECIFIED Drinhaus, Hendrik UNSPECIFIED https://orcid.org/0000-0001-8435-2246 UNSPECIFIED Dusse, Fabian UNSPECIFIED https://orcid.org/0000-0001-7762-6966 UNSPECIFIED Böttiger, Bernd W. UNSPECIFIED https://orcid.org/0000-0001-8000-8931 UNSPECIFIED Mathes, Alexander UNSPECIFIED https://orcid.org/0000-0002-0231-0681 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-792896
Identification Number:	10.1186/s12871-025-02904-7
Journal or Publication Title:	BMC Anesthesiology
Volume:	25
Number:	1
Page Range:	pp. 1-9
Date:	1 February 2025
Publisher:	BioMed Centra
ISSN:	1471-2253
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Anästhesiologie und Operative Intensivmedizin > Klinik für Anästhesiologie und Operative Intensivmedizin
Subjects:	Medical sciences Medicine
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/79289