Airway pressure release ventilation in acute severe asthma: a case series and physiologic framework

The article describes the use of airway pressure release ventilation (APRV) in six adult patients with acute severe asthma and severe hypercapnia. Before APRV initiation, patients had PaCO2 values ranging from 62–136 mm Hg and pH 6.68–7.20. Following transition to APRV, PaCO2 decreased to 39–48 mm Hg and pH improved to 7.30–7.41 within 4 to 48 hours. Four of five patients were extubated within 48 hours and none required extracorporeal membrane oxygenation. No new complications such as barotrauma occurred during APRV application. The results suggest that APRV may be an effective rescue mode in refractory obstructive respiratory failure; however, further controlled studies are needed to confirm its role.