6/27/23, 11:44 PM BILEVEL-APRV Pathway Feedback Search Clinical Topics Home Studies BILEVEL APRV BILEVEL APRV Disease Acute respiratory distress syndr Trial question What is the effect of early application of airway pressure release ventilation in patients with ARDS? Study design Single center Open label RCT Population Characteristics of study participants 34.0% female N = 138 66.0% male 138 patients (47 female, 91 male) Inclusion criteria: patients with ARDS who received mechanical ventilation for < 48 hours Key exclusion criteria: anticipated duration of invasive mechanical ventilation < 48 hours; intracranial hypertension; severe COPD; barotrauma; refractory shock; pregnancy Interventions N=71 airway pressure release ventilation (bi-level airway pressure ventilation-airway pressure release ventilation mode, combination with spontaneous breathing) N=67 low tidal volume lung protective ventilation (volume-controlled ventilation or pressure- controlled ventilation mode combination with adequate PEEP level) Primary outcome Number of days without mechanical ventilation at 28 days 19.0 days 19 https://web.pathway.md/studies/recC3ZpeuG3hEoaFD 1/2 6/27/23, 11:44 PM BILEVEL-APRV Pathway 14.3 days 9.5 days 4.8 days Significant increase 2 0.0 days Airway pressure release ventilation Low tidal volume lung protective ventilation Significant increase in the number of days without mechanical ventilation at 28 days (19 days vs. 2 days; AD 17 days, 95% CI 6.91 to 27.09) Secondary outcomes No significant difference in death during ICU stay (19.7% vs. 34.3%; RR 0.57, 95% CI -0.01 to 1.15) Significant decrease in length of ICU stay (15 days vs. 20 days; AD -5 days, 95% CI -9.03 to -0.97) No significant difference in length of hospital stay (21 days vs. 27 days; AD -6 days, 95% CI -12.14 to 0.14) Safety outcomes No significant differences in pneumothorax between day 1 and day 28, receipt of inhaled nitric oxide, and high-frequency oscillatory ventilation. Significant differences in successful extubation (66.2% vs. 38.8%), tracheostomy (12.7% vs. 29.9%), and receipt of neuromuscular blockers (2.8% vs. 13.4%). Conclusion In patients with ARDS who received mechanical ventilation for < 48 hours, airway pressure release ventilation was superior to low tidal volume lung protective ventilation with respect to number of days without mechanical ventilation at 28 days. Reference Yongfang Zhou, Xiaodong Jin, Yinxia Lv et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med. 2017 Nov;43(11):1648-1659. Open reference URL https://web.pathway.md/studies/recC3ZpeuG3hEoaFD 2/2