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Airway pressure release ventilation in children

Saptharishi Lalgudi Ganesan1

  • 1Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Current Opinion in Critical Care
|December 6, 2018
PubMed

Insights

Airway Pressure Release Ventilation (APRV) offers benefits for pediatric acute respiratory distress syndrome (ARDS). Recent trials provide insights, but a consensus on APRV strategies is needed, especially avoiding specific personalized approaches in moderate-severe ARDS.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Airway Pressure Release Ventilation (APRV) is a mechanical ventilation mode with purported physiological benefits in acute respiratory distress syndrome (ARDS).
  • Recent clinical trials have re-examined the use and efficacy of APRV in both adult and pediatric populations.
  • These trials have sparked renewed debate regarding optimal APRV settings and strategies.

Purpose of the Study:

  • To synthesize recent research evaluating the APRV mode in pediatric patients with ARDS.
  • To provide perspectives on the clinical utility and application of APRV in children.
  • To contextualize new evidence within the existing body of literature on APRV.

Main Methods:

  • Review of recent single-center clinical trials on APRV, including one pediatric trial.
  • Analysis of published editorials and letters discussing the strengths and weaknesses of recent APRV studies.
  • Comprehensive literature synthesis to analyze APRV use in pediatric ARDS.

Main Results:

  • Two recent trials, one adult and one pediatric, offer contrasting results but significant insights into APRV strategies.
  • The trials highlight variability in APRV effectiveness and the need for refined understanding.
  • Recent advancements have improved comprehension of APRV's clinical utility in pediatric ARDS.

Conclusions:

  • A consensus on the definition and effective strategies for APRV in pediatric ARDS is urgently required.
  • Clinicians should exercise caution and avoid a zero-Positive End-Expiratory Pressure (PEEP) or Lung Occlusion (PLOW) Personalized-APRV strategy as a primary approach for moderate-to-severe pediatric ARDS.
  • Further research is necessary to establish definitive guidelines for APRV implementation in pediatric ARDS.
Abstract

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