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Airway Pressure Release Ventilation

As originally described by Stock and Downs, airway pressure release ventilation (APRV) uses continuous positive airway pressure (CPAP) applied at a high level with intermittent releases of airway pressure. Conceptually, APRV applies a continuous airway pressure (Phigh) to maintain adequate lung volume and promote alveolar recruitment. However, APRV adds a time-cycled release phase to periodically decompress the airway to a lower set pressure (Plow). Any spontaneous breathing occurs unimpeded and independent of the ventilator cycle through an open biphasic positive airway pressurecircuit. CPAP breathing more closely mimics gas distribution of normal breathing as opposed to mechanically controlled breaths that produce a less physiological gas distribution. APRV has been used in neonatal, pediatric, and adult respiratory failure (Figure 1). Some machines provide support resembling APRV in modes called biphasic positive airway pressure (BiPAP) or Bilevel. BiPAP is identical to APRV except that no restriction is imposed on the duration of the low-pressure level or release pressure. In accordance with its original description, APRV keeps the duration of the low-pressure level (release time) at 1.5 seconds or less.