Airway pressure release ventilation: A pediatric case series

Abstract

Summary. Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation (MV) first described in animal studies in 1987 and in humans in 1988. It is a timetriggered, time-cycled, pressure-limited mode where a high level of continuous positive airway pressure (CPAP) is maintained with brief regular releases in pressure, and spontaneous breathing is allowed throughout the cycle. In theory, it is consistent with a lung protective approach while having some hypothetical advantages over HFOV. The use of this mode of ventilation in pediatrics has been limited. The authors describe their experience with this mode of ventilation in a series of pediatric patients.

Airway Pressure Release Ventilation: An Alternative Ventilation Mode for Pediatric Acute Hypoxemic Respiratory Failure

“…Data obtained from present cases support the notion that APRV can improve oxygenation in some children with AHRF as in Krishan case series [9]. Krishan et al showed that oxygenation index improved in several of their patients managed with APRV but there was no data about lung mechanics.…”

“…Previous studies and case reports in adult patients suggest that APRV provides a benefit by allowing oxygenation and ventilation to patients with acute lung injury (ALI) and ARDS [1][2][3][4][5]. There is limited data about the benefits of APRV in children [8][9][10]. In this paper, authors have presented three patients with AHRF whose oxygenation did not improve with conventional ventilation and were treated with APRV.…”

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

“…To be effective, these modes can require a mean airway pressure 5 cmH 2 O higher than that used with conventional ventilation. This can reduce venous return leading to greater need for fluid resuscitation and vasopressor requirements [612][613][614][615][616].…”

Surviving Sepsis Campaign

“…This can reduce venous return leading to greater need for fluid resuscitation and vasopressor requirements (612)(613)(614)(615)(616). Some patients with ARDS will require increased PEEP to attain functional residual capacity and maintain oxygenation, and peak pressures above 30 to 35 cm H 2 O to attain effective tidal volumes of 6 to 8 mL/kg with adequate CO 2 removal.…”