Evidence-based clinical pathway development for airway pressure release ventilation in adult acute respiratory distress syndrome: Findings from a rapid literature review

Abstract

Clinical pathways (CPs) are structured, multidisciplinary plans that translate evidence into practice to improve care quality and consistency. Airway pressure release ventilation (APRV) is an advanced ventilator mode with potential benefits for adults with acute respiratory distress syndrome (ARDS), yet its implementation lacks standardised protocols. In South African critical care settings, nurses often adjust ventilators and respond to clinical changes without respiratory therapists or immediate physician oversight, highlighting the need for structured, evidence-informed support. To synthesise evidence on APRV ventilator settings, protocols and implementation considerations to inform the development of an evidence-based clinical pathway for APRV therapy to treat adults with ARDS. A rapid literature review of peer-reviewed studies published from January 2016 to July 2022 was conducted. Searches were performed in PubMed, EBSCOhost Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar. Twenty-one studies meeting eligibility criteria were analysed using descriptive thematic synthesis, focusing on APRV protocols, ventilator parameters, sedation strategies and alarm guidance. No universally accepted APRV protocol was identified. Implementation is largely guided by institution-specific protocols and physician preference. Sedation management is recognised as essential, but detailed recommendations are limited. Information on alarm limits and safety parameters within the mode is minimal. These findings emphasise the variability and uncertainty in APRV practice and the importance of context-specific, evidence-informed CPs.
Contribution: Clear pathways can standardise care, improve patient safety and strengthen multidisciplinary collaboration in critical care settings.