Airway pressure release ventilation in pediatrics

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• Mechanical ventilation is crucial for pediatric patients with respiratory compromise.
• Synchronized intermittent mechanical ventilation (SIMV) and Airway Pressure Release Ventilation (APRV) are common modes.
• Comparative effectiveness data for APRV in pediatric populations is limited.

Purpose of the Study:

• To evaluate the efficacy of Airway Pressure Release Ventilation (APRV) in pediatric patients.
• To compare APRV with volume-controlled synchronized intermittent mechanical ventilation (SIMV) in terms of ventilation, oxygenation, and patient comfort.
• To assess airway pressures during APRV and SIMV in children.

Main Methods:

• Prospective, randomized, crossover clinical trial in a pediatric intensive care unit.
• Patients (>8 kg) received both SIMV and APRV modes.
• Measurements included vital signs, airway pressures, oxygen saturation (SpO2), and end-tidal carbon dioxide (ETCO2).

Main Results:

• APRV demonstrated comparable ventilation, oxygenation, mean airway pressure, hemodynamics, and patient comfort to SIMV.
• Inspiratory airway pressures were significantly lower with APRV compared to SIMV.
• No significant differences in vital signs or SpO2 were observed between the two modes.

Conclusions:

• APRV is a viable alternative to SIMV in children with mild to moderate lung disease.
• APRV achieves similar physiological support with reduced peak and plateau airway pressures.
• Future studies will investigate APRV's effectiveness in pediatric patients with severe lung disease.