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Mechanical Ventilation II: Invasive Ventilation01:23

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Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
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Mechanical Ventilation III: Noninvasive Ventilation01:23

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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
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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
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Summary

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.

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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.