2012 OPEN FORUM Abstracts
RETROSPECTIVE REVIEW OF AIRWAY PRESSURE RELEASE VENTILATION IN NEONATES.
Cathy Bardua, Amy Weber, Melissa Coon, Stacy Dornette, Paul Kingma; Cincinnati Childrens Hospital, Cincinnati, OH
RATIONALE Airway Pressure Release Ventilation (APRV) is a relatively new mode of ventilation that uses prolonged inspiratory times to achieve high mean airway pressures with lower peak pressures. Although this creates an inverse inspiratory:expiratory ratio, which historically was associated with an increased risk of pneumothorax with previous modes of neonatal ventilation, this complication is theoretically reduced in APRV by allowing exhalation during all phases of the respiratory cycle. In adult and pediatric literature APRV has been shown to improve oxygenation when conventional ventilation (pressure control and SIMV) has failed, however there is very limited evidence regarding APRV in the neonatal population. We hypothesize that APRV is a safe and effective mode of ventilation in neonates that fail conventional ventilation. METHODS This is a retrospective study of all infants that failed conventional ventilation and required rescue ventilation with either High Frequency Oscillatory Ventilation (HFOV) or APRV at our institution from January 2010 to March 2011. RESULTS Forty six infants were identified that required rescue ventilation with either HFOV (n=28), APRV (n=9) or both APRV and HFOV (n=9). The mean gestational age was 30 weeks in the HFOV group, 33 weeks in the APRV group, and 32 weeks in the infants treated with both. Survival was 50% in the HFOV group, 78% in the APRV group, and 89% in infants rescued with both APRV and HFOV. Peak inspiratory pressures significantly decreased when transitioning from conventional ventilation to APRV (25.3 vs 22.5 cm H2O, p=0.0017) with no decrease in oxygenation. Ventilation also improved when transitioning from conventional ventilation to APRV (pCO2 77 vs 61 mm Hg, p=0.01) and was similar to ventilation achieved in infants rescued with HFOV (pCO2 63 mm Hg). Although earlier modes of inverse inspiratory:expiratory ventilation were associated with increased risk of pneumothorax, the incidence of pneumothorax in our population was 11%, 14%, and 6% while on conventional, HFOV and APRV, respectively. CONCLUSIONS While larger studies are needed to determine the impact of APRV on outcome variables such as survival and chronic lung disease, our results suggest that APRV decreases peak inspiratory pressures, and improves ventilation with no increase in the incidence of pneumothorax. Sponsored Research - None