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Impact of airway pressure release ventilation mode on vasopressors and sedation in patients with Septic Shock

Reda Nasef , Waleed Farouk , Rasha Elnahas , Ahmed Samir , Waheed Radwan


Introduction: Generally, airway pressure release ventilation (APRV) simply is defined as a pressure–controlled manner that permits natural breathing through the ventilation set. It enhances significantly organ perfusion through increasing in both venous return and cardiac index. The primary outcome of the current study is to assess the valuable of using APRV in cases of septic shock patients returns hemodynamics constancy earlier than the controlled mechanical ventilation (CMV) method. The secondary outcome is to validate whether the application of APRV improves the survival in the ICU, decrease the length of ICU stay; decrease the ventilator days and whether it decrease the need for sedation and neuromuscular blockers (NMBS) compared to CMV mode. Methods: We prospectively evaluated the clinical documents of forty septic shock patients who given invasive mechanical ventilation from November 2014 to August 2015 at Department of Critical Care, Faculty of Medicine, Cairo University, Egypt. Patients were randomized into two groups according to the mode of ventilation (APRV and CMV groups). All included patients were subjected to resuscitation for septic shock for control of septic shock in patients depending on the instructions of surviving sepsis campaign international guidelines (2013), full clinical evaluation, routine microbiological and laboratory investigations. Patients were followed up daily to assess their clinical course, length of ICU stay, duration of mechanical ventilation, dosages and duration of vasopressors, dosage and duration for sedation and if needed NMBS and their final outcome. Results: The initial time to start recovery from septic shock was significantly earlier in APRV compared to CMV patients (13.7 ± 4.6 hours versus 21.3 ± 8.5 hours, P< 0.001). The need for sedation or NMBS was statistical significantly higher in CMV compared to APRV patients with a P: 0.010 and 0.028 respectively. CMV patients had statistical insignificantly longer ICU length of stay and duration of mechanical ventilation. APRV mode did not reduced mortality compared to CMV. Conclusion: The application of APRV mode in patients with septic shock to return hemodynamic constancy former than the CMV manner, decreases the need of sedation and NMBS.

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