The effect of APRV ventilation on ICP and cerebral hemodynamics

Neurocrit Care. 2012 Oct;17(2):219-23. doi: 10.1007/s12028-012-9739-4.


Background: Airway pressure release ventilation (APRV) is an alternative approach to the low-tidal volume "open-lung" ventilation strategy. APRV is associated with a higher mean airway pressure than conventional ventilation and has therefore not been evaluated in patients with acute neurological injuries.

Methods: Case report.

Results: We report a patient with severe progressive hypoxemia following a subarachnoid hemorrhage who was converted from pressure-controlled mechanical ventilation to APRV. This change in ventilatory mode was associated with a significant improvement in oxygenation and alveolar ventilation with an associated increase in cerebral blood flow and a negligible increase in intracranial pressure.

Conclusion: APRV may safely be applied to neurocritically ill patients, and that this mode of ventilation may increase cerebral blood flow without increasing intracranial pressure.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Brain / blood supply*
  • Brain / physiopathology
  • Continuous Positive Airway Pressure / methods*
  • Female
  • Humans
  • Hypoxia / therapy*
  • Intracranial Pressure
  • Regional Blood Flow
  • Respiratory Distress Syndrome / therapy*
  • Subarachnoid Hemorrhage / therapy*