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Dynamic hyperinflation and auto-PEEP remained clinically unrecognized long after the era of positive pressure ventilation had begun.
APRV raises mean airway pressure higher than standard ventilation; foregoes tight control over true maximal trans-alveolar pressure; and deliberately generates unmeasured and variable levels of auto-PEEP.
Decreased patient-ventilator synchrony can cause elevated Auto-PEEP, leading to delayed triggering or even wasted triggering efforts.
Auto-PEEP - Positive End Expiratory Pressure (PEEP) that is not set by the clinician.
In using very brief release times, APRV seeks to maintain auto-PEEP of a level sufficient to prevent widespread airway closure.