Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome
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ORIGINAL ARTICLE
Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome Nazik Yener 1
&
Muhammed Üdürgücü 1
Received: 18 July 2019 / Accepted: 3 February 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objectives 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. Methods 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. Results 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%. Conclusions 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. Keywords Pediatric acute respiratory distress syndrome . Airway pressure release ventilation . Mechanical ventilation
Introduction Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure, characterised by severe diffuse inflammation and hypoxemia that poses a significant threat to patients of all age groups. Currently, lung-protective ventilation strategies, including open lung and low-tidal-volume, are among the major ARDS mechanical ventilation strategies to prevent ventilator-induced lung injury for both adults and children [1]. Despite advancements in our understanding of lung-protective low-tidal-volume ventilation, the mortality associated with pediatric ARDS remains high and has changed little in the last 20 years (22–40%) [2, 3]. No consensus has been reached on the optimal mode of ventilation for pediatric ARDS patients refractory to conventional mechanical ventilation (CMV) using
* Nazik Yener [email protected] 1
Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
low tidal volume combined with sufficient positive end expiratory pressure (PEEP). Over the past 3 decades, such patients have commonly transitioned from CMV to high frequency oscillation ventilation (HFOV) for refractory hypoxemia or to limit cyclic high peak pressures [1]. Unfortunately, there is a lack of relevant HFOV research on pediatric populations as only one small cohort randomized controlled trial (RCT) has been conducted [4]. Approximately 20
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