Table 2 Indications and practice of using APRV mode with ARDS patients (n = 1,002)
Variables | Values, n% |
|---|---|
Section 1: indication and other strategy to improve oxygenation | |
 Conditions APRV mode utilization is indicated | |
  ARDS | 672 (67.1%) |
  COVID-19 | 468 (46.7%) |
  Pneumonia | 362 (36.1%) |
  Asthma | 176 (17.6%) |
  Pulmonary edema | 174 (17.4%) |
  Obesity-induced hypoventilation syndrome | 148 (14.8%) |
  COPD | 147 (14.7%) |
  Sleep apnea syndrome | 57 (5.7%) |
 Strategy to improve oxygenation when conventional MV fails to improve oxygenation | |
  Prone positioning | 444 (43.8%) |
  High-frequency oscillatory ventilation (HFOV) | 191 (19.1%) |
  Airway pressure release ventilation (APRV) | 157 (15.7%) |
  Extracorporeal membrane oxygenation (ECMO) | 111 (11.1%) |
  Inhaled nitric oxide | 60 (6.0%) |
  Other pulmonary vasodilators | 39 (3.9%) |
Section 2: initial settings and management | |
 Initial P-high setting | |
  Equal to the plateau pressure on conventional ventilator | 323 (32.2%) |
  At 25 cmH2O | 227 (22.6%) |
  Equal to the mean airway pressure on conventional ventilator | 211 (21.1%) |
  2—5 cmH2O above mean airway pressure on conventional ventilator | 170 (17.0%) |
  To achieve tidal volume of 6 ml/kg/pbw (predicted body weight) | 71 (7.1%) |
 Initial P-low setting | |
  Match to PEEP from conventional ventilator | 400 (39.9%) |
  0 cmH2O | 217 (21.7%) |
  2—5 cmH2O | 237 (23.6%) |
  Variable depending upon oxygenation | 148 (14.8%) |
 Initial T-high setting | |
  2–3 s | 171 (17.1%) |
  4–6 s | 446 (44.5%) |
  Per desired minute ventilation and respiratory rate | 260 (25.9%) |
  Per inspiratory to expiratory (I:E) ratio | 125 (12.5%) |
 Initial T-low setting | |
  Set time (i.e. 0.4–0.8 s) | 415 (41.4%) |
  Per inspiratory to expiratory (I:E) ratio | 265 (26.4%) |
  When expiratory flow equals 25 – 49% peak expiratory flow | 246 (24.5%) |
  When expiratory flow equals 50–75% peak expiratory flow | 76 (7.6%) |
 Maximum allowed tidal volume | |
  4–6 ml/kg | 540 (53.9%) |
  7–8 ml/kg | 210 (21.0%) |
  9–10 ml/kg | 134 (13.4%) |
  More than 10 ml/kg | 59 (5.9%) |
  No limit | 59 (5.9%) |
 Maximum allowed P-high | |
  30 cmH2O | 123 (12.3%) |
  35 cmH2O | 475 (47.4%) |
  40 cmH2O | 324 (32.3%) |
  No maximum | 80 (8.0%) |
 Pressure support utilization during spontaneous breathing | |
  Yes | 588 (58.7%) |
  No | 414 (41.3%) |
Section 3: weaning and discontinuation | |
 Criteria use to wean P-high | |
  Reduce P-high gradually in attempt to reach a target of 20 cmH2O | 234 (23.3%) |
  Reduce P-high gradually in attempt to reach a target of 15 cmH2O | 309 (30.8%) |
  Reduce P-high gradually in attempt to reach a target of 10 cmH2O | 329 (32.8%) |
  Reduce P-high gradually in attempt to reach a target of 5 cmH2O | 130 (13.0%) |
 Criteria use to wean T-high | |
  Increase T-high gradually in attempt to reach a target of 7 s | 252 (25.1%) |
  Increase T-high gradually in attempt to reach a target of 10 s | 444 (44.3%) |
  Increase T-high gradually in attempt to reach a target of 15 s | 245 (24.4%) |
  Increase T-high gradually in attempt to reach a target of 20 s | 61 (6.1%) |
 Criteria used to switch ARDS patients to CPAP | |
  FiO2 ≤ 40% | 167 (16.7%) |
  T-high ≥ 10 s | 148 (14.8%) |
  P-high ≤ 10cmH2O | 131 (13.1%) |
  (FiO2 ≤ 40%, T-high ≥ 10 s and P-high ≤ 10cmH2O) | 556 (55.5%) |