What are the roles of partial liquid ventilation and airway pressure release ventilation for the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Partial liquid ventilation

Partial liquid ventilation has also been tried in ARDS. A randomized controlled trial that compared it with conventional mechanical ventilation determined that partial liquid ventilation resulted in increased morbidity (pneumothoraces, hypotension, and hypoxemic episodes), and a trend toward higher mortality. [47]

Airway pressure release ventilation

Airway pressure release ventilation (APRV) is another ventilatory mode that uses a long duration (T high) of a high positive airway pressure (P high) followed by a short duration (T low) at a low pressure (P low). The time spent at a P high as compared with P low is an inverse ratio to normal breathing patterns. For example, a patient may spend 5.2 seconds at P high and 0.8 seconds at P low. The theory is that time at P high significantly increases and maintains alveolar recruitment, thereby improving oxygenation. APRV may improve oxygenation, but there have been no randomized controlled trials demonstrating improved survival with ARDS. Physicians should exercise caution with APRV in patients with obstructive lung disease, owing to the relatively short exhalation time and possible hyperinflation and barotrauma.


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