Airway Pressure Release Ventilation Improves Oxygenation in a Patient with Pulmonary Hypertension and Abdominal Compartment Syndrome


The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after abdominal closure from an incarcerated umbilical hernia. A 66-year-old male with past medical history of restrictive lung disease, obstructive sleep apnea and pulmonary hypertension, presented to the operating room for an incarcerated inguinal hernia. After abdominal closure, he gradually developed decreased oxygen saturation and hypotension. APRV was initiated during post operative day 2 after inability to maintain adequate oxygen saturation with resultant hypotension on pressure control ventilation with varying degrees of positive end expiratory pressure and 100% inspired oxygen concentration. The initial set high pressure on APRV was 35 mm Hg. Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide was initiated post operative day 3 due to increasing pulmonary arterial pressures. A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally improved the oxygen saturation and decreased the pulmonary arterial pressures with subsequent increase in systemic blood pressures. APRV promoted alveolar recruitment and decreased the shunting associated with abdominal compartment syndrome. Better oxygen saturations lead to increases in blood pressure by decreasing the effects of hypoxic pulmonary vasoconstriction on the right ventricle (RV). In patients with decreasing lung compliance and pulmonary comorbidities, APRV appears safe and allows for improve oxygenation, after failure with conventional modes of ventilation.

Share and Cite:

A. Torres, R. Tostenrud and E. Lujan, "Airway Pressure Release Ventilation Improves Oxygenation in a Patient with Pulmonary Hypertension and Abdominal Compartment Syndrome," Open Journal of Anesthesiology, Vol. 3 No. 1, 2013, pp. 14-17. doi: 10.4236/ojanes.2013.31005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. Steier, S. Kaul, J. Seymour, et al., “The Value of Multiple Tests of Respiratory Muscle Strength,” Thorax, Vol. 62, No. 11, 2007, pp. 975-980. doi:10.1136/thx.2006.072884
[2] M. L. Malbrain, M. L. Cheatham, A. Kirkpatrick, et al., “Results from the International Conference of Experts on Intra-Abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions,” Intensive Care Medicine, Vol. 32, No. 11, 2006, pp. 1722-1732.
[3] J. Strumpher and E. Jacobsohn, “Pulmonary Hypertension and Right Ventricular Dysfunction: Physiology and Perioperative Management,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 10, No. 6, 2011, pp. 687-704.
[4] P. S. Myles, J. L. Hall, C. B. Berry, et al., “Primary Pulmonary Hypertension: Prolonged Cardiac Arrest and Successful Resuscitation following Induction of Anesthesia for Heart-Lung Transplantation,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 8, No. 6, 1994, pp. 678-681. doi:10.1016/1053-0770(94)90203-8
[5] D. B. Badesch, H. C. Champion, M. A. Sanchez, et al., “Diagnosis and Assessment of Pulmonary Arterial Hypertension,” Journal of the American College of Cardiology, Vol. 54, No. 1, 2009, pp. S55-S66. doi:10.1016/j.jacc.2009.04.011
[6] R. Dallari, G. Barozzi, G. Pinelli, et al., “Predictors of Survival in Subjects with Chronic Obstructive Pulmonary Disease Treated with Long-Term Oxygen Therapy,” Respiration, Vol. 61, No. 1, 1994, pp. 8-13. doi:10.1159/000196296
[7] D. J. Dries and J. J. Marini, “Airway Pressure Release Ventilation,” Journal of Burn Care & Research, Vol. 10, No. 6, 2009, pp. 929-936.
[8] F. Ichinose, J. D. Roberts Jr. and W. M. Zapol, “Inhaled Nitric Oxide: A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential,” Circulation, Vol. 109, 2004, pp. 3106-3111. doi:10.1161/01.CIR.0000134595.80170.62
[9] “Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. The Acute Respiratory Distress Syndrome Network,” The New England Journal of Medicine, Vol. 342, No. 18, 2000, pp. 1301-1308.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.