Indian Journal of Respiratory Care

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VOLUME 4 , ISSUE 1 ( January-June, 2015 ) > List of Articles


Biphasic positive airway pressure and Airway pressure release ventilation

Handattu Mahabaleswara Krishna

Keywords : Airway pressure release ventilation, Biphasic positive airway pressure, Mechanical ventilation

Citation Information : Krishna HM. Biphasic positive airway pressure and Airway pressure release ventilation. Indian J Respir Care 2015; 4 (1):542-546.

DOI: 10.5005/jp-journals-11010-04103

License: NA

Published Online: 02-12-2022

Copyright Statement:  NA


Biphasic positive airway pressure (BIPAP) and Airway pressure release ventilation (APRV) are two commonly used modes of ventilation. BIPAP is widely used as a ‘universal mode of ventilation’ for both invasive and noninvasive mechanical ventilation. Understanding the functioning of this mode helps in ventilation with this mode alone for all levels of support. APRV is a variant of BIPAP and offers benefits for protective lung ventilation. Allowing patient's spontaneous respiration unhindered at all phases of ventilation is the hallmark of these modes. The ventilatory characteristics, difference from the conventional pressure controlled ventilation (PCV), ventilatory settings, technique of weaning, indications, contraindications, advantages and disadvantages of these two modes of ventilation are described in this article.

  1. Henzler D. What on earth is APRV? Critical Care 2011; 15:115.
  2. Baum M, Benzer H, Putensen C, Koller W, Putz G. Biphasic Positive Airway Pressure (BIPAP) - a new form of augmented ventilation. Anaesthesist 1989; 38: 452-8.
  3. Stock MC, Downs JB, Frolicher DA. Airway pressure release ventilation. Crit Care Med 1987; 15: 462–6.
  4. Hörmann C, Baum M, Putensen C, Mutz NJ, Benzer H. Biphasic Positive Airway Pressure (BIPAP) - a new mode of ventilatory support. Eur J Anaesthesiol 1994; 11: 37-42.
  5. Rathgeber J, Schorn B, Falk V, Kazmaier S, Spiegel T, Burchardi H. The influence of controlled mandatory ventilation (CMV), intermittent mandatory ventilation (IMV) and biphasic intermittent positive airway pressure (BIPAP) on duration of intubation and consumption of analgesics and sedatives: A prospective analysis in 596 patients following adult cardiac surgery. Eur J Anaesthesiol 1997; 14:576–82.
  6. Putensen C, Zech C, Wrigge H, Zinserling J, Stüber F, Von Spiegel T, et al. Long term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 2001; 164: 43–9.
  7. Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, et al. Spontaneous breathing improves lung aeration in oleic acid induced lung injury. Anesthesiology 2003; 99:376–84.
  8. Sydow M, Burchardi H, Ephraim E, Zielmann S, Crozier TA. Long term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume controlled inverse ratio ventilation. Am J Respir Crit Care Med 1994; 149:1550–6.
  9. Putensen C, Mutz N, Putensen-Himmer G, Zinserling J. Spontaneous breathing during ventilatory support improves ventilation/perfusion distribution in patients with ARDS. Am J Respir Crit Care Med 1999; 159:1241–8.
  10. Kaplan LJ, Bailey H, Formosa V. Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome. Crit Care 2001; 5:221–6.
  11. Hering R, Veihofer A, Zinserling J, Wrigge H, Kreyer S, Berg A, et al. Effects of spontaneous breathingduring airway pressure release ventilation on intestinal blood flow in experimental lung injury. Anesthesiology 2003; 99:1137–44.
  12. Hering R, Zinserling J, Wrigge H, Varelmann D, Berg A, Kreyer S, et al. Effects of spontaneous breathing during airway pressure release ventilation on respiratory work and muscle blood flow in experimental lung injury. Chest 2005; 128:2991–8.
  13. Cane RD, Peruzzi WT, Shapiro BA. Airway pressure release ventilation in severe acute respiratory failure. Chest 1991; 100:460-3.
  14. Walkey AJ, Nair S, Papadopoulos S, Agarwal S, Reardon CC. Use of airway pressure release ventilation is associated with a reduced incidence of ventilator-associated pneumonia in patients with pulmonary contusion. J Trauma 2011; 70:E42–E47.
  15. Field S, Kelly SM, Macklem PT. The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 1982; 126:9-13.
  16. Uyar M, Demirag K, Olgun E, CanKayali I, Moral AR. Comparison of oxygen cost of breathing between pressure support ventilation and airway pressure release ventilation. Anaesth Intensive Care 2005; 33: 218-22.
  17. Kallet RH. Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 2: airway pressure release ventilation. Respir Care 2011; 56:190-206.
  18. Myers TR, MacIntyre NR. Does airway pressure release ventilation offer important new advantages in mechanical ventilator support? Respir Care 2007; 52:452-60.
  19. Pribble CG, Berg MD. Pneumothorax as a complication of bilevel positive airway pressure (BiPAP) ventilation. Clinical Intensive Care 2000; 11:145-7.
  20. Maung AA, Luckianow G, Kaplan LJ. Lessons learned from airway pressure release ventilation. J Trauma Acute Care Surg 2012; 72:624-8.
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