Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome

• DOI: 10.1007/s12098-020-03235-w
• Publication Date: 2020-03-03T13:03:08Z
• Authors: Nazik Yener; Muhammed Üdürgücü
• Keywords: Airway pressure release ventilation; Respiratory Distress Syndrome; Continuous Positive Airway Pressure; Pediatric acute respiratory distress syndrome; Respiration, Artificial; 3. Good health; 03 medical and health sciences; Mechanical ventilation; 0302 clinical medicine; Tidal Volume; Humans; Original Article; Child; Lung

To describe experience with airway pressure release ventilation (APRV) in children with severe acute respiratory distress syndrome (ARDS) refractory to conventional low tidal volume ventilation.This retrospective observational study was performed in an 11-bed, level 3 pediatric intensive care unit. Evaluation was made of 30 pediatric patients receiving airway pressure release ventilation as rescue therapy for severe ARDS.Patients were switched to APRV on an average 3.2 ± 2.6 d following intubation. When changed from conventional mechanical ventilation (CMV) to APRV, there was an expected increase in the SpO2/FiO2 ratio (165.1 ± 13.6 vs. 131.7 ± 10.2; p = 0.035). Mean peak inspiratory pressure was significantly lower during APRV (25.4 ± 1.26 vs. 29.8 ± 0.60, p < 0.001) compared to CMV prior to APRV but mean airway pressure (Paw) was significantly higher during APRV (19.1 ± 0.9 vs. 15.3 ± 1.3, p < 0.001). Hospital mortality in this study group was 16.6%.The results of this study support the hypothesis that APRV may offer potential clinical advantages for ventilatory management and may be considered as an alternative rescue mechanical ventilation mode in pediatric ARDS patients refractory to conventional ventilation.