Does setting the breathing machine (ventilator) to deliver breaths using a method called airway pressure release ventilation help patients with diseased lungs to heal faster and spend less time on a ventilator?

Not Applicable

Conditions: Moderate to severe acute hypoxaemic respiratory failure (AHRF)
Respiratory

Registration Number: ISRCTN17158033

Lead Sponsor: niversity of Warwick

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Ongoing

Sex: All

Target Recruitment: 710

Inclusion Criteria

1. Age =18 years
2. Receiving invasive mechanical ventilation
3. Moderate to severe AHRF (PaO2/FiO2 <20 kPa with Positive End Expiratory Pressure (PEEP) =5 cmH2O) assessed at the time of screening (or as documented in the medical record in the preceding 2 hours)
4. Expected to stay on invasive mechanical ventilation for >48 hours

Exclusion Criteria

1. Receiving IMV =60 hours at the time of screening as will be unable to deliver early APRV
2. Primary reason for invasive mechanical ventilation is one of the following:
2.1. Asthma
2.2. Severe COPD
2.3. Pulmonary embolism (massive or sub-massive) (as cause of hypoxaemia is not primarily due to collapse of lung tissue)
2.4. Existing neuromuscular disease such as motor neurone disease, Guillain Barre or myasthenia gravis (as the cause of respiratory failure is not primarily lung-related)
3. Refractory shock (systolic blood pressure < 90 mmHg, despite fluid administration and vasoactive drugs)*
4. Severe hypercapnic respiratory acidosis (pH <7.20 on the arterial blood gas assessed for trial inclusion)*
5. Ongoing air leak (e.g. unresolved pneumothorax at time of screening)*
6. Traumatic brain injury with uncontrolled intracranial hypertension*
7. Likely death or treatment withdrawal in the next 24 hours
8. Home ventilation or home oxygen therapy prior to admission
*(patients can be recruited if this resolves and remain eligible)

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Duration of invasive mechanical ventilation (defined as the time from randomisation to first successful unassisted breathing or death) measured using data collected from site staff at the time of first successful unassisted breathing or death

Secondary Outcome Measures