The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

AIRWAY PRESSURE RELEASE VENTILATION IN A PEDIATRIC POPULATION

Rebecca I. Jones, BS, RRT, Troy D. Roberts, BS, RRT, David W. Christensen, M.D., St. Luke's Regional Medical Center, Boise, ID

Background: 7 pediatric patients aged 3 to 13yrs. with Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS) and severe hypoxemia, in the St. Luke's Regional Medical Center Children's Hospital have been treated with Airway Pressure Release Ventilation (APRV). Previous investigators have reported that children can be treated using APRV with lower peak pressures while fostering the ability to spontaneously breathe. All 7 patients had been on other modes of ventilation (High Frequency Oscillatory Ventilation (HFOV), Pressure Regulated Volume Control (PRVC), SIMV, and/or BiPAP) prior to treatment with APRV.

Results: Lower peak pressures, lower FiO2 requirements and improved oxygenation were observed with all 7 patients. Paralytics were successfully discontinued in 4 patients after initiation of APRV. Data was collected on all 7 patients to see if there was a common factor that would produce the improved response with the use of APRV.

Measurements:

  Mode Ti FiO2 Peak Peep Mean Paralytic
Patient A SIMV 0.80 1.0 44.0 4.0 17.5 yes
  APRV Th 4.5 0.65 35.0 5.0 29.0 no
    Tl .8          
Patient B PRVC 0.85 0.70 36.0 8.0 16.0 no
  APRV Th 2.0 0.60 28.0 8.0 24.0 no
    Tl .5          
Patient C BiPAP   1.0 15.0 5.0   no
  APRV Th 2.8 0.50 28.0 5.0 22.0 no
    Tl .5          
Patient D HFOV 0.39 1.0 40.0   27.0 yes
  ARPV Th 2.5 0.50 35.0 5.0 29.0 no
    Tl .4          
Patient E SIMV 0.80 0.55 28.0 8.0 15.0 no
  APRV Th 3.5 0.35 22.0 0.0 18.0 no
    Tl 0.5          
Patient F HFOV 0.40 0.60 44.0   18.0 yes
  APRV Th 2.5 0.30 25.0 1.0 20.0 no
    Tl .5          
Patient G PRVC 0.80 0.80 39.0 8.0 23.0 yes
  APRV Th 2.9 0.40 35.0 1.0 30.0 no
    Tl .4          

Ti= inspiratory time; Th= hold time; Tl= release time

Conclusions: All 7 patients responded to APRV with the common finding of a higher mean airway pressure than was used in the previous mode of ventilation accompanied by improved oxygenation and the ability to discontinue paralytics. Delta P was reduced and there were no symptoms of lung injury noted. In these patients it appears APRV may have been effective due to the increase in mean airway pressure. The data suggests that APRV is a safe and potentially beneficial therapeutic alternative to other modes of ventilation in children with ALI or RDS.