APRV vs. BIPAP Ventilation in COVID-19 Associated ARDS

link.springer.com February 3, 2025

Despite of higher mean tidal volumes and higher mean airway pressures in airway pressure release ventilation (APRV) vs. biphasic positive airway pressure (BIPAP), both modes did not present an increased risk of volu- or barotrauma regarding median endinspiratory transpulmonary pressures (TPP).

In contrast, in APRV- mode, median endexpiratory TPP was negative (versus positive in BIPAP) implying an increased risk of atelectasis in APRV which would have remained unwitnessed without TPP-monitoring.

Conclusively, TPP monitoring could be a useful tool for a safer application of APRV- mode in patients suffering from COVID19-associated ARDS (CARDS).

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.