Airway pressure release ventilation as a recruitment maneuver in mechanically ventilated children with restrictive...

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation Strategies

Background:

• Restrictive lung disease (RLD) frequently causes acute-on-chronic respiratory failure in children, necessitating invasive mechanical ventilation.
• Current consensus on lung recruitment maneuvers for pediatric RLD is lacking.
• Airway Pressure Release Ventilation (APRV) is a potential open-lung tool for managing RLD.

Purpose of the Study:

• To evaluate the efficacy of APRV as an open-lung recruitment maneuver in pediatric patients with RLD.
• To assess the impact of APRV on lung surface area, atelectasis, and oxygenation in this population.

Main Methods:

• A single-center retrospective case series was conducted in a pediatric intensive care unit from 2013 to 2024.
• Included were patients with RLD experiencing acute-on-chronic respiratory failure requiring invasive mechanical ventilation for at least 48 hours, with at least 24 hours on APRV.
• Patients were categorized into neuromuscular disease and truncal obesity groups.

Main Results:

• Eighteen patient encounters met the inclusion criteria.
• APRV use significantly improved lung surface area in both neuromuscular (7,600 mm², p<0.001) and obesity (15,000 mm², p=0.018) groups within 12-24 hours.
• Atelectasis decreased by 14% (p=0.005 at 12-24h, p=0.009 at 48h), and oxygenation improved substantially in both groups.

Conclusions:

• APRV demonstrates safety and effectiveness in improving lung aeration and oxygenation for pediatric RLD patients with neuromuscular conditions and obesity.
• Further high-quality prospective research is warranted to establish definitive clinical guidelines for APRV use in this patient cohort.