{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T14:15:52Z","timestamp":1791728152668,"version":"4.3.4"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We conducted a roundtable discussion and provided evidence-based guidance on the setting and adjustment of Airway Pressure Release Ventilation (APRV) in adult patients with acute respiratory distress syndrome (ARDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A panel of clinicians and basic scientists with extensive experience in lung physiology and using APRV was assembled to provide expert consensus guidance. The panel first established and agreed upon guiding principles for optimal APRV settings. To support consensus discussions, we then reviewed the literature on the physiological basis of APRV as a lung-protective ventilation strategy, as well as published APRV research. Finally, we held a one-day meeting and conducted robust, iterative consensus discussions using the Nominal Group Technique to reach agreement on the optimal APRV settings. This work represents an Expert Recommendation and Position Statement rather than a formal consensus guideline. The recommendations were developed through iterative expert discussions that integrated extensive clinical experience with supporting basic science evidence on time-controlled ventilation and alveolar mechanics. Recommendations were based on expert experience with APRV in the intensive care unit and supported by published animal and clinical studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Consensus on initial APRV settings for acute lung injury (ALI) such as ARDS or disorders of normal or increased elstance was as follows: set the upper airway pressure (P\n                      <jats:sub>High<\/jats:sub>\n                      ) to either plateau or peak inspiratory pressure when transitioning from volume control or pressure control\/dual control, respectively; set the duration of P\n                      <jats:sub>High<\/jats:sub>\n                      (T\n                      <jats:sub>High<\/jats:sub>\n                      ) to match the current respiratory rate on conventional ventilation; set lower airway pressure (P\n                      <jats:sub>Low<\/jats:sub>\n                      ) to 0 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O; and calculate duration of P\n                      <jats:sub>Low<\/jats:sub>\n                      (T\n                      <jats:sub>Low<\/jats:sub>\n                      ) using the equation Peak Expiratory Flow x 75%\u202f=\u202fTermination of Expiratory Flow. Other recommendations included titrating these settings in response to changes in lung physiology and reaching consensus on injurious APRV settings that could impair gas exchange or cause lung instability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The panel developed a protocol for adjusting the four APRV settings based on expert experience and solid clinical and scientific evidence for patients with ALI and ARDS, or disorders of normal or increased elastance. Optimizing the lung-protective settings in APRV mode can improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1741129","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T06:29:45Z","timestamp":1770100185000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Expert recommendations for setting and adjusting airway pressure release ventilation based on clinical experience and basic science evidence"],"prefix":"10.3389","volume":"13","author":[{"given":"Gary F.","family":"Nieman","sequence":"first","affiliation":[{"name":"Department of Surgery, Upstate Medical University","place":["Syracuse, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H. T.","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Medicine, Larner College of Medicine, University of Vermont","place":["Burlington, VT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny L.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department Critical Care, University of Maryland Medical Center \u2013 R Adams Cowley Shock Trauma Center","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Rose","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King\u2019s College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Shiber","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine, Neurology, and Surgery, University of Florida College of Medicine","place":["Jacksonville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin","family":"Araos","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University","place":["Ithaca, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ledoux","family":"Aurelien","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, CHU HELORA - Jolimont","place":["La Louvi\u00e8re, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Madden","sequence":"additional","affiliation":[{"name":"Department Critical Care, University of Maryland Medical Center \u2013 R Adams Cowley Shock Trauma Center","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Manougian","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Westchester Medical Center, New York Medical College","place":["Valhalla, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Satalin","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine, Cornell University","place":["Ithaca, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Varpula","sequence":"additional","affiliation":[{"name":"Division of Intensive Care, Department of Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital","place":["Helsinki, Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Al-khalisy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary Disease, Sleep and Critical Care Medicine, East Carolina University","place":["Greenville, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjunath","family":"Markandaya","sequence":"additional","affiliation":[{"name":"Neurocritical Care, NorthEast Georgia Medical Center","place":["Gainesville, GA, United States"]},{"name":"Department of Critical Care Medicine, MedStar St. Mary's Hospital","place":["Leonardtown, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Leme","family":"Silva","sequence":"additional","affiliation":[{"name":"Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro","place":["Rio de Janeiro, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Felipe","family":"da Fonseca Reis","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Rehabilitation Sciences, Centro Universit\u00e1rio Augusto Mota (UNISUAM)","place":["Rio de Janeiro, Brazil"]},{"name":"Intensive Care Unit, Central Hospital of the Military Police of the State of Rio de Janeiro","place":["Rio de Janeiro, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Downs","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Florida College of Medicine","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Camporota","sequence":"additional","affiliation":[{"name":"Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Shepherd's House, Guy's Campus, King\u2019s College London","place":["London, United Kingdom"]},{"name":"Guy\u2019s & St Thomas\u2019 NHS Foundation Trust","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader M.","family":"Habashi","sequence":"additional","affiliation":[{"name":"Department Critical Care, University of Maryland Medical Center \u2013 R Adams Cowley 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Physiol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1097\/CCM.0000000000004416","article-title":"Time course of evolving ventilator-induced lung injury: the \"shrinking baby lung\"","volume":"48","author":"Marini","year":"2020","journal-title":"Crit Care Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1186\/s13054-022-04105-x","article-title":"Unshrinking the baby lung to calm the VILI vortex","volume":"26","author":"Nieman","year":"2022","journal-title":"Crit Care"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s13054-018-2051-8","article-title":"Acute lung injury: how to stabilize a broken lung","volume":"22","author":"Nieman","year":"2018","journal-title":"Crit Care"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s40635-017-0138-1","article-title":"The role of high airway pressure and dynamic strain on ventilator-induced lung injury in a heterogeneous 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dynamics?","volume":"41","author":"Protti","year":"2013","journal-title":"Crit Care Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1007\/s10439-010-0237-6","article-title":"Quantifying the roles of tidal volume and PEEP in the pathogenesis of ventilator-induced lung injury","volume":"39","author":"Seah","year":"2011","journal-title":"Ann Biomed Eng"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1007\/s00134-005-2627-z","article-title":"The concept of \"baby lung\"","volume":"31","author":"Gattinoni","year":"2005","journal-title":"Intensive Care Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1378\/chest.121.4.1245","article-title":"Changes in BP induced by passive leg raising predict response to fluid loading in critically ill 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