Abstract
Patients with acute lung injury present with a spectrum of respiratory failure ranging from mild arterial hypoxemia with intact pulmonary mechanics to severe intrapulmonary shunting of blood and overt ventilatory insufficiency. Of the three components of respiratory therapy — continuous positive airway pressure (CPAP), oxygen supplementation, and positive pressure mechanical ventilation — only CPAP can be expected to reverse any of the pathophysiologic alterations causing the symptoms of hypoxemia and increased respiratory work [1, 2]. Mild acute lung injury can be treated successfully using relatively low levels of CPAP to correct hypoxemia and to improve derangement in ventilatory mechanics, adding oxygen supplementation as necessary. Mechanical ventilatory assistance rarely is indicated in mild cases. More severe cases of acute lung injury require higher levels of CPAP to decrease respiratory work, but once optimum CPAP is applied, the patient still may be able to breathe spontaneously without difficulty. In severe cases of acute lung injury, however, ventilatory failure often is present, even with optimum CPAP therapy, and mechanical ventilatory assistance must be initiated.
Keywords
- Acute Lung Injury
- Spontaneous Breathing
- Peak Airway Pressure
- Airway Pressure Release Ventilation
- Mechanical Ventilatory Assistance
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References
Kirby RR, Downs JB, Civetta JM, et al (1975) High level positive end-expiratory pressure (PEEP) in acute respiratory insufficiency. Chest 67:156–163.
Katz JA, Marks JD (1985) Inspiratory work with and without continuous positive airway pressure in patients with acute respiratory failure. Anesthesiology 63:598–607.
Montgomery AB, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patient with the adult respiratory distress syndrome. Am Rev Respir Dis 132:485–489.
Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41:242–255.
Wolff G, Brunner JX, Grädel E (1986) Gas exchange during mechanical ventilation and spontaneous breathing. Chest 89:11–17.
Downs JB, Stock MC (1987) Airway pressure release ventilation: A new concept in ventilatory support. Crit Care Med 15:459–461.
Stock MC, Downs JB, Frolicher DA (1987) Airway pressure release ventilation. Crit Care Med 15:462–466.
Räsänen J, Downs JB, Stock MC. Cardiovascular effects of conventional positive pressure ventilation and airway pressure release ventilation. Chest (In press).
Garner W, Downs JB, Stock MC, Räsänen J. Airway pressure release ventilation (APRV) (Submitted for publication).
Väisänen IT, Nikki P, Tahvanainen J. Airway pressure release ventilation by mask — A case report. Crit Care Med (In Press).
Halpern P, Downs JB, Räsänen J. Hemodynamic effects of airway pressure release ventilation and positive pressure ventilation in hypovolemic dogs (Submitted for publication).
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© 1988 Springer-Verlag Berlin Heidelberg
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Räsänen, J., Downs, J.B. (1988). Airway Pressure Release Ventilation. In: Vincent, J.L. (eds) Update 1988. Update in Intensive Care and Emergency Medicine, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83392-2_95
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DOI: https://doi.org/10.1007/978-3-642-83392-2_95
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-18981-7
Online ISBN: 978-3-642-83392-2
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