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REDUCED NEUROMUSCULAR BLOCKADE REQUIREMENTS IN PATIENTS RECEIVING AIRWAY PRESSURE RELEASE VENTILATION

Georgetown University Hospital, Washington, DC

PURPOSE: Pressure control ventilation (PCV) is used to limit airway pressures in patients with acute respiratory distress syndrome (ARDS), however it frequently requires neuromuscular blockade (NMB) and heavy sedation for patient comfort. Airway pressure release ventilation (APRV) is an alternative pressure-limited mode of ventilation that allows spontaneous breathing throughout the ventilator cycle and appears to reduce NMB and sedation requirements. We reviewed the use of neuromuscular blockade in patients on APRV and PCV in the medical intensive care unit (ICU).

METHODS: We conducted a chart review of all patients who received invasive mechanical ventilation in the medical ICU of a university hospital from September 2002 until March 2005. APRV was introduced to this hospital in September 2003 and has been used in place of PCV since then. The period of September 2002 to September 2003 was examined to determine frequency of NMB use in patients on PCV. In all patients receiving PCV or APRV we recorded mode of ventilation used, use of neuromuscular blockade, and survival to ICU and hospital discharge.

RESULTS: One of the 52 patients on APRV required NMB in the past 18 months compared to the majority of patients on PCV. We are completing the chart review of PCV patients and expect that more than 60% of these patients received NMB.

CONCLUSION: Use of APRV may significantly reduce NMB requirements compared to PCV. APRV should be the preferred pressure-limited mode of ventilation in patients who have failed volume cycled ventilation.

CLINICAL IMPLICATIONS: APRV appears to offer a pressure-limited mode of ventilation that requires significantly less NMB than PCV. The effects of APRV on sedation requirements and development of critical illness polyneuropathy need to be evaluated.

DISCLOSURE: Tristan Huie, None.