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Airway pressure-release ventilation (APRV) is a pressure-limited, time-cycled mode of mechanical ventilation. The purpose of this study was to evaluate our initial experience with the use of APRV in acutely injured, ventilated patients.Since March 2003, APRV has been used selectively in adult trauma patients with or at risk for acute lung injury/acute respiratory distress syndrome. Data were obtained before and during the 72 hours after switching to APRV. A retrospective analysis of these data was then performed.Complete data were available on 46 of 60 patients (77%) for the first 72 hours of APRV. Before APRV, the average Pao2/Fio2 ratio was 243 and the average peak airway pressure was 28 cm H2O. Peak airway pressure decreased 19% (p = 0.001), Pao2/Fio2 improved by 23% (p = 0.017) and release tidal volumes improved by 13% (p = 0.020) over the course of the analysis.APRV significantly improved oxygenation by alveolar recruitment and allowed for a reduction in peak airway pressures. This relatively new modality had favorable results and appears to be an effective alternative for lung recruitment in traumatically injured patients at risk for acute lung injury/acute respiratory distress syndrome.