Health Sciences Program Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Guy M. Nehrenz

Publication Date / Copyright Date

2017

Publisher

Nova Southeastern University

Abstract

There are few recommendations on how best to apply certain modes of mechanical ventilation. The application of Airway Pressure Release Ventilation (APRV) includes strategic implementation of specific inspiratory times (I-times) and particular mean airway pressures (MAWP) neither of which is standardized. This study utilized a retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for at least 8 hours. 68 adult subjects were evaluated as part of a convenient purposive sample. All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FiO2 (P/F) ratio, Oxygen Index and Oxygen Saturation Index (OI; OSI), and Modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after at least 8 hours on APRV. Most notably, there was significant improvement in P/F ratio (p = .012) and OSI (p = .000). Results of regression analysis showed P low as a statistically significant negative predictor of pre-APRV P/F ratio with a higher initial P low coinciding with a lower P/F ratio. The regression analysis also showed MAWP as a significant positive predictor of post-APRV OSI and P high and P low as significant negative predictors of post-APRV MSOFA scores. In summary, it was found that settings for P high, Plow, and T low in addition to overall MAWP and Body Mass Index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured.

Disciplines

Medicine and Health Sciences

Keywords

Health and environmental sciences, Airway pressure release ventilation, Critical care, Inspiratory times, Mechanical ventilation, Positive pressure ventilation, Respiratory therapy

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