Efficacy of airway pressure release ventilation for acute respiratory distress syndrome: A meta-analysis

Background: Airway pressure release ventilation (APRV) has been described many years, however, it is still unclear whether APRV improves outcomes in critically ill patients admitted to Intensive Care Unit with acute respiratory distress syndrome (ARDS). Methods 3 databases were searched for randomized controlled trials (RCTs) until 8 August 2019. The relative risk (RR), mean difference (MD) and 95% confidence intervals (CI) were determined. Results A total of six randomized controlled trials (RCTs) were included with 360 ARDS patients. The Meta analysis showed that the mean arterial pressure (MAP) in APRV group is higher than traditional mechanical ventilation group [MD = 2.35, 95% CI=(1.05,3.64), P  = 0.0004], and the airway peak pressure (Ppeak) is lower in APRV group with statistical difference [MD=-2.04,95% CI=(-3.33,-0.75), P  = 0.002]. However, no significant beneficial effect on oxygen index (PaO 2 /FiO 2 ) was shown between two groups (MD = 26.24, 95% CI=(-26.50,78.97), P  = 0.33). Compared with conventional mechanical ventilation, APRV significantly improved 28-day mortality [RR = 0.66, 95% CI=(0.47,0.94), P  = 0.02]. Conclusions For critically ill patients with ARDS, application of APRV is associated with the increase of MAP, the reduction of the airway Ppeak and 28-day mortality, while there is no sufficient evidence to support the APRV is superior to conventional mechanical ventilation in PaO 2 /FiO 2 .