What is APRV and when is it used?

• A. Assist-control ventilation; not used in ARDS
• B. Continuous positive airway pressure; not a ventilation mode
• C. Bilevel positive airway pressure with spontaneous breaths; not APRV
• D. Airway Pressure Release Ventilation; maintains high baseline pressure with brief releases; used to improve oxygenation in ARDS

Answer: (D)

Airway Pressure Release Ventilation is a two-level mode that keeps the airway at a high pressure for a long period to recruit and keep alveoli open, then briefly drops to a lower pressure to allow exhalation and CO2 removal. Spontaneous breaths are encouraged, especially at the high pressure, which can reduce the work of breathing. The goal is to improve oxygenation in ARDS by raising the mean airway pressure and maintaining lung recruitment, while the short releases prevent overdistension during exhalation and help with CO2 clearance. Other modes described involve either delivering fixed breaths or maintaining a continuous pressure without the deliberate long plateau and short release pattern, so they don’t provide the same recruitment-focused approach that APRV offers for ARDS.