[Airway pressure release in postoperative cardiac surgery in pediatric patients]

Area of Science:

• Pediatric critical care medicine
• Cardiothoracic surgery
• Respiratory physiology

Background:

• Pulmonary hypertension is a significant concern in pediatric cardiac surgery patients postoperatively.
• Mechanical ventilation (MV) strategies aim to optimize gas exchange and reduce pulmonary complications.

Purpose of the Study:

• To compare three modes of mechanical ventilation: intermittent mandatory ventilation with positive end-expiratory pressure (IMV + PEEP), airway pressure release ventilation (APRV), and continuous positive airway pressure (CPAP).
• To evaluate the effects of these ventilation modes on respiratory and cardiocirculatory variables in pediatric patients with pulmonary hypertension after cardiac surgery.

Main Methods:

• A study involving ten pediatric patients undergoing cardiac surgery with pulmonary hypertension.
• Utilized respiratory monitoring and analyzed cardiocirculatory variables including central venous pressure (CVP) and oxygen extraction ratio.
• Employed nonparametric statistical tests (Friedman's and Wilcoxon) for data analysis.

Main Results:

• Airway pressure release ventilation (APRV) resulted in significantly higher mean airway pressure (MAP) compared to IMV + PEEP.
• APRV led to a significant decrease in respiratory rate and an increase in tidal volume compared to CPAP and IMV + PEEP.
• Central venous pressure (CVP) significantly increased during APRV, with no significant differences in other cardiocirculatory variables or gas exchange parameters (PaO2/FiO2).

Conclusions:

• Airway pressure release ventilation (APRV) achieved higher tidal volumes with increased mean airway pressure without adverse respiratory or cardiocirculatory effects in this pediatric cohort.
• The findings suggest that APRV is a simple and safe ventilation strategy for children with pulmonary hypertension following cardiac surgery.