2012 OPEN FORUM Abstracts
THE RETROSPECTIVE REVIEW OF THE RESPONSE TO APRV IN TWENTY SIX PICU PATIENTS WITH RESPIRATORY FAILURE BEFORE AND AFTER THE IMPLEMENTATION OF APRV.
Tracey Roberts1, Julie Williamson1,2, Swetha Kambhampati3,2, Solomon Messing4,2, Saraswati Kache1,2; 1Lucile Packard Childrens Hospital at Stanford, Palo Alto, CA; 2Stanford University School of Medicine, Palo Alto, CA; 3MD candidate, Stanford University School of Medicine, Palo Alto, CA; 4PhD candidate, Communications, Lucile Packard Childrens Hospital at Stanford, Palo Alto, CA
BACKGROUND: Airway Pressure Release Ventilation (APRV) is used to provide a constant airway pressure with minimal release phases. APRV allows for the optimization of alveolar recruitment during a long time-high, thus improving oxygenation, and allows for ventilation during short release phases or time-low. By using lower inflation pressures and preserving spontaneous breathing, APRV acts as a lung protective strategy. In this study, we evaluated the recruitment capabilities of APRV and used the PaO2/FIO2 (P/F) ratio and Oxygen Index (OI) as proxies to evaluate this outcome. METHOD: Retrospective chart review of 26 pediatric patients up to 18 years of age diagnosed with respiratory failure and placed on APRV were assessed. Patients were transitioned to APRV from other modes of ventilation due to decompensating clinical status with oxygenation difficulty. Parameters analyzed included the P/F ratio and OI content at both 2 and 24 hours before and after conversion to APRV. The data was evaluated for significant differences over time using a mixed linear model with a random effect for each patient. RESULTS: Both the P/F ratio and OI improved dramatically once patients were converted to APRV (table 1. The P/F ratio was increased by a mean difference of 28.5 (CI 3.44 to 58.51). The OI steadily increased for the 24 hours prior to APRV conversion and then steadily declined for the 24 hours after. Improvements in the P/F ratio and OI within 24 hours of conversion to APRV exhibit promising results for rapid pulmonary re-recruitment in severe lung injury and have implications for pediatric patients in respiratory failure. CONCLUSION: APRV implementation in infant and pediatric patients demonstrates potential for improvement in oxygenation for patients afflicted with respiratory failure. The need for randomized controlled trials to assess the efficacy of APRV in children with respiratory failure is needed. Sponsored Research - None P/F ratio and OI Parameters before and after APRV initiation