Mechanical ventilation management and airway pressure release ventilation practice in acute respiratory distress syndrome: A cross‐sectional survey of intensive care unit clinicians in mainland China

Abstract

Abstract Background Airway pressure release ventilation (APRV) has become increasingly popular for the management of acute respiratory distress syndrome (ARDS); however, its clinical impact remains a topic of debate. Furthermore, there is a gap between the guidelines and the actual clinical practices in mechanical ventilation management for ARDS. This survey aimed to explore the utilization of APRV and mechanical ventilation strategies for ARDS in Chinese intensive care unit (ICU) clinicians. Methods A comprehensive 34‐item survey was distributed online platforms amongst ICU clinicians across mainland China from June to August 2019. Results A total of 420 valid responses were collected, with 57.4% (241) originating from academic hospitals and 42.6% (179) from non‐academic hospitals. Of the respondents, 98.6% (414) recognized the significance of low tidal volume ventilation for ARDS prognosis, 85.2% adhered to a tidal volume below 8 mL/kg predicted body weight, and most (46.4%) selected the initial positive end‐expiratory pressure within the range of 5–10 cmH2O based on experience. Among the respondents, 62.1% (261) reported familiarity with APRV and 41.9% (176) had implemented APRV. Of those who had utilized APRV, 93.2% (164) believed in its effectiveness for ARDS patients and 69.3% (122) advocated for early application of APRV. Substantial variations were noted regarding APRV initiation settings and the preservation of spontaneous breathing during APRV. Academic hospitals exhibited higher usage rates of lung recruitment, neuromuscular blockade, prone ventilation, and acquaintance with and utilization of APRV compared to non‐academic hospitals (all p values ≤ 0.001). Conclusions Our findings highlight opportunities for improvement in mechanical ventilation management for ARDS, particularly in non‐academic hospitals. Additionally, a significant proportion of clinicians demonstrated limited knowledge of APRV, and there was a lack of consensus on its application. Further training and larger‐scale clinical trials are required to validate the efficacy and utilization of APRV in managing ARDS.

Keywords

• acute respiratory distress syndrome
• airway pressure release ventilation
• mechanical ventilation
• survey