2004 OPEN FORUM Abstracts
Airway Pressure Release Ventilation (APRV) in a pediatric burn patient complicated by Inhalation Injury and Acute Respiratory Distress Syndrome.
Carman
B, RRT, Cahill T, RRT, Berwanger M, BSN, RRT, Meyer N, MD, Warden
G, MD, FACS, McCall J, MD
BACKGROUND: Airway pressure release ventilation (APRV)
is a mode of mechanical
ventilation, which allows unrestricted spontaneous breathing
throughout the breathing cycle. APRV is consistent with a lung
protective strategy of ventilation that attempts to limit lung injury
associated with mechanical ventilation. APRV has been used
successfully in the adult patient population, but not extensively in
the pediatric burn patient population.
CASE REPORT: A 5 year
old child with acute respiratory distress syndrome (ARDS) secondary
to 90% TBSA burn with severe inhalation injury developed respiratory
failure which was refractory to conventional ventilation strategies
as evidenced by PaCO2 57 and PaO2 70. Nitric Oxide (NO) therapy with
permissive hypercapnia was initiated but oxygenation did not improve.
APRV was initiated 24 hours later. Spontaneous breathing during
APRV resulted in improved oxygenation with PaO2 increased to 118.
The patient was weaned from mechanical ventilation over time. Follow
up pulmonary function testing demonstrated no adverse long-term
effects of the ventilation strategy employed, or from ARDS or
inhalation injury.
CONCLUSION: APRV, which allows
spontaneous breathing by the patient, combined with NO therapy, can
be a safe and effective for the treatment of inhalation injury
complicated by ARDS refractory to conventional modes of ventilation.