Active Lungs & Breathing NIHR-supported project Pregnancy, Children & Inherited Conditions

RELEASE: CoReCCT: Airway Pressure Release Ventilation (APRV) vs conventional ventilation for patients with moderate to severe acute hypoxemic respiratory failure

Funder NIHR (part of DHSC)
Recipient organisation NIHR HealthTech Research Centre in Cardiovascular and Respiratory Medicine
NIHR support Recorded as supported by this research centre
Period Feb 2025 — Jun 2029

In plain English

AI plain-English summary

A large UK trial is testing whether a specific ventilator setting—one that keeps the lungs open under continuous pressure with brief release pauses—can save more lives than standard breathing support for patients with severe respiratory failure. Around half of patients with acute hypoxemic respiratory failure die in intensive care. Current mechanical ventilation can further damage already-inflamed lungs. Airway Pressure Release Ventilation (APRV) is already available on every NHS ICU ventilator, but no large randomised trial has proven whether using it early improves survival or reduces costs. This trial will randomise patients across multiple NHS critical care units to receive either APRV or conventional lung-protective ventilation, with outcomes tracked rigorously. If APRV proves superior, the NHS could adopt a cost-neutral change in ventilator settings that improves oxygenation and reduces lung injury without purchasing new equipment. If it does not, clinicians will have clear evidence to avoid a widely used but unproven mode. Either way, the trial provides the robust data needed to standardise care for one of the most common and lethal conditions in intensive care.

View original technical description
This multi-centre, pragmatic, parallel-group randomised controlled trial (RCT) will assess the clinical and cost effectiveness of early airway pressure release ventilation (APRV) compared to conventional lung-protective invasive mechanical ventilation (IMV) in patients with moderate-to-severe acute hypoxic respiratory failure (AHRF). Eligibility criteria are designed to pragmatically include patients most likely to benefit from early APRV, while exclusions focus on avoiding those with conditions that may either reduce potential benefit or increase the risk of harm. All ventilated patients in critical care units (CCUs) will be screened daily by medical or nursing staff. Each site will maintain a screening log, recording all potentially eligible patients, reasons for non-enrolment, and anonymised baseline data (e.g. age, sex, ethnicity), in accordance with CONSORT reporting standards. As most patients will lack capacity due to sedation, delirium, or critical illness, consent will follow legal frameworks for patients without capacity. A personal or professional consultee will be approached to provide agreement on their behalf. Once eligibility and consent are confirmed, participants will be randomised on a 1:1 basis using an automated web-based system, with stratification by site and prior enrolment in the Awake Prone Positioning or Protect Airways trials. Randomisation will use randomly permuted blocks and be managed by the Warwick Clinical Trials Unit. The intervention arm will receive APRV, a mode of ventilation available on all NHS ICU ventilators. APRV uses prolonged inspiratory times and brief expirations to maintain alveolar recruitment and improve oxygenation. This trial aims to determine whether early initiation of APRV improves outcomes and offers a cost-effective alternative to standard IMV for patients with AHRF. The robust RCT design ensures minimal bias and supports real-world applicability of findings across multiple NHS settings.

Researchers

Luigi Campora (Principal Investigator)

Related Research

Grants with similar aims, by meaning.

Airway Pressure Release Ventilation (APRV) vs conventional ventilation for patients with moderate to severe acute hypoxemic respiratory failure (RELEASE)
Neurally Adjusted Ventilatory Assist (NAVA) in the adult critical care unit: A randomised, parallel group, allocation concealed, controlled, open, phase 3 pragmatic clinical and cost-effectiveness trial with internal pilot: The UK NAVA Trial
A randomised feasibility study examining neurally-adjusted ventilatory assist (NAVA) in patients at high risk of prolonged ventilatory failure during recovery from critical illness.
FIRST-line support for Assistance in Breathing in Children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high flow nasal cannula therapy versus continuous positive airway pressure for non-invasive respiratory support in paediatric critical care
The clinical and cost effectiveness of advanced airways protection device versus conventional endotracheal tubes in Intensive care unit patients requiring mechanical ventilation: a multicentre, pragmatic randomised clinical trial.

Original classification

Advanced Respiratory Monitoring, Imaging and Treatment

Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.