The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

AIRWAY PRESSURE RELEASE VENTILATION IN PEDIATRICS: A CASE SERIES^{3}

Theresa R. Schultz, BA. RRT, Suzanne M. Durning, BS, RRT, Linda A. Napoli, BS, RRT, Gregory Schears, MD. The Children's Hospital of Philadelphia, Philadelphia, PA

Previous investigators have reported that Airway Pressure Release Ventilation (APRV) provides ventilation at lower airway pressures than Volume Control Ventilation (VCV) in adults. In 1995, we took a conservative approach to investigating APRV in children. After studying eight patients, we found that pediatric patients can be adequately ventilated with lower airway pressures utilizing APRV when compared to conventional ventilation.

Unrestricted spontaneous breathing was noted to be an additional benefit. While considering these outcomes, it was decided to utilize APRV outside the criteria for study, on pediatric patients with Adult Respiratory Distress Syndrome (ARDS).

This is a one year old former premature infant with parainfluenza pneumonia who progressed to respiratory failure despite aggressive medical intervention. The patient required intubation and mechanical ventilation upon arrival to the PICU. He was placed on V-A ECMO for pulmonary rest after he developed bilateral pneumothoraces, requiring four chest tubes. Chest x-rays revealed worsening radiodensity with diffuse white out. Mechanical ventilation was manipulated with the goal to minimize the perpetuation of lung injury. These manipulations included CPAP alone as well as Pressure Control, Volume Control, SIMV, Assist Control, with variable levels of pressure, volume and time. In an attempt to realize the benefit of spontaneous breathing while utilizing minimal mechanical airway pressures, APRV was initiated. Blood gas analysis confirmed adequate ventilation. CXR improved.

1400 SIMV RR=10/min Ti=1 sec. FiO_{2}=1.0

0300 APRV RR=10/min T_{1}=3 sec FiO_{2}=.21

T_{2}=3sec

1400 Peak=35cmH_{2}O PEEP=5cmH_{2}O

0300 P_{max}=25cmH_{2}O P_{min}=5cmH_{2}O

^{2}This is a 5 year old who developed respiratory failure secondary to Influenza-A. She progressed to ARDS, requiring mechanical ventilation and subsequently V-A ECMO. After all reversible processes were alleviated, the patient was liberated from ECMO. Unable to wean the patient from the mechanical ventilator, it was decided to place the patient in APRV. The goal was to train the patient to breathe spontaneously while giving her adequate pressure levels. Ventilation seemed to occur effectively and the patient was successfully liberated from mechanical ventilation in less than two weeks. ^{3}This is a 6 mos. old with Epstein's Anomaly s/p ECMO as bridge to heart transplant. Post transplantation, weaning this patient from mechanical ventilation became difficult. Most methods of weaning this patient were attempted and failed. Despite many manipulations in all parameters and sensitivity, this patient had difficulty triggering the ventilator. Airway Pressure Release Ventilation was used in this situation to foster this patient's ability to spontaneously breathe. This patient became successful in her ability to spontaneously breathe in APRV.

0900 SIMV RR=14/min. Ti=0.8 sec Peak=40cmH_{2}O

1300 APRV RR=16/min. T_{1}=1.9sec P_{max}=25 cm H_{2}O

T_{2}=1.9sec

0900 PEEP=7 cmH_{2}O FiO_{2}=.30

1300 P_{min}=7 cmH_{2}O FiO_{2}=.30

Conclusion: In these patients it seems that Airway Pressure Release Ventilation was a safe and effective alternative to conventional mechanical ventilation.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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