Airway pressure release ventilation: an alternative ventilation mode for pediatric acute respiratory distress syndrome

Introduction

The purpose of the present data is to determine whether airway pressure release ventilation (APRV) can improve oxygenation in pediatric patients with acute respiratory distress syndrome relative to pressure-controlled ventilation (PCV).

Methods

Data about the patients with acute respiratory distress syndrome whose oxygenation was not improved with conventional ventilation and switched to APRV were collected retrospectively.

Results

Five patients were switched from conventional ventilation to APRV. Of these five, three patients responded to APRV with improvement in oxygenation. The mean age of the responders was 5.8 ± 1.3 (4.3–7.4) months. The fractional oxygen concentration decreased from 96.6 ± 2.3% for PCV to 68.3 ± 11.5% for APRV, the peak airway pressure fell from 36.6 ± 11.5 cmH₂O for PCV to 33.3 ± 5.7 cmH₂O for APRV, the mean airway pressure increased from 17.9 ± 5.9 cmH₂O for PCV to 27 ± 2.6 cmH₂O for APRV and the release tidal volume increased from 8.3 ± 1.5 ml/kg for PCV to 13.2 ± 1.1 ml/kg for APRV at the first hour (Table 1). Of the two nonresponders, both had primary acute respiratory distress syndrome and one of them had prior ventilation history. We suggested that the lungs of the nonresponders were not recruitable.

Table 1 Conventional ventilation versus APRV

Conclusion

APRV may improve oxygenation in pediatric ARDS patients when conventional ventilation does not work. APRV modality may provide better oxygenation with lower peak airway pressure. The recruitability of the lungs may affect the response to APRV.