Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome

Yener, Nazik; Üdürgücü, Muhammed

doi:10.1007/s12098-020-03235-w

Cited by 9 publications

(7 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar study found that survival in immunocompromised patients with ARDS was significantly associated with improved oxygenation 24 h after transition to APRV or HFOV (102). A recent retrospective analysis of 30 pediatric patients with severe PARDS transitioned from CMV to APRV for refractory hypoxemia found that the SpO 2 / FiO 2 ratio increased from 132 to 165, likely secondary to increased mPaw with a lower PIP, and a mortality rate of 17% (103). Previous small pediatric case series/case reports also observed improved oxygenation at lower peak airway pressure (93,94,97,99) and no adverse hemodynamic effects (95,96).…”

Section: Retrospective Case Seriesmentioning

confidence: 84%

“…Disadvantages of APRV include difficulty of controlling VT, concern for atelectrauma during releases (especially in lung units with low compliance and resistance), and exposure to high transpulmonary pressure during spontaneous breathing at P-high. Current data evaluating APRV in children are limited to single center case series as a rescue mode for patients with refractory hypoxemia and one small, single center RCT (93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103).…”

Section: Aprvmentioning

confidence: 99%

See 1 more Smart Citation

A narrative review of advanced ventilator modes in the pediatric intensive care unit

Miller¹,

Bartle²,

Feldman³

et al. 2021

Transl Pediatr

View full text Add to dashboard Cite

Respiratory failure is a common reason for pediatric intensive care unit admission. The vast majority of children requiring mechanical ventilation can be supported with conventional mechanical ventilation (CMV) but certain cases with refractory hypoxemia or hypercapnia may require more advanced modes of ventilation. This paper discusses what we have learned about the use of advanced ventilator modes [e.g., high-frequency oscillatory ventilation (HFOV), high-frequency percussive ventilation (HFPV), high-frequency jet ventilation (HFJV) airway pressure release ventilation (APRV), and neurally adjusted ventilatory assist (NAVA)] from clinical, animal, and bench studies. The evidence supporting advanced ventilator modes is weak and consists of largely of single center case series, although a few RCTs have been performed. Animal and bench models illustrate the complexities of different modes and the challenges of applying these clinically. Some modes are proprietary to certain ventilators, are expensive, or may only be available at well-resourced centers. Future efforts should include large, multicenter observational, interventional, or adaptive design trials of different rescue modes (e.g., PROSpect trial), evaluate their use during ECMO, and should incorporate assessments through volumetric capnography, electric impedance tomography, and transpulmonary pressure measurements, along with precise reporting of ventilator parameters and physiologic variables.

show abstract

Section: Retrospective Case Seriesmentioning

confidence: 84%

Section: Aprvmentioning

confidence: 99%

A narrative review of advanced ventilator modes in the pediatric intensive care unit

Miller¹,

Bartle²,

Feldman³

et al. 2021

Transl Pediatr

View full text Add to dashboard Cite

show abstract

“… [82] 2010 America Crossover APRV vs. CV 12 P plat or PIP Higher than T low PEEP Higher than T low Increased Increased P mean Similar / / Yehya et al . [51] 2013 America Crossover APRV vs. HFOV 104 P mean / 0 cm H 2 O 50–75% PEF / / / / Similar ofsurvival Yener and Udurgucu [83] 2020 Turkey Crossover APRV vs. CV 30 / / 0 cm H 2 O Prevents end-expiratory pressure from reaching zero Increased Reduced PIP, increased P mean / / / Kawaguchi et al . [84] 2015 Japan Case series APRV 13 P plat 3.0–5.0 s 0 cm H 2 O 0.2–0.6 s Similar Increased P mean Similar / / ALI: Acute lung injury; APRV: Airway Pressure Release Ventilation; ARDS: Acute respiratory distress syndrome; CV: Conventional ventilation; HFOV: High frequency oscillatory ventilation; LTV: Low tidal volume; PEEP: Positive end expiratory pressure; PEF: Peak expiratory flow; PEFR: Peak expiratory flow rate; P high : High pressure; PIP: Inspiratory peak pressure; P low : Low pressure; P mean : Mean airway pressure; P plat : Platpressure; RCT: Randomized controlled study; SIMV: Synchronized intermittent mandatory ventilation; T high : High pressure time; T ...…”

Section: Application Of Aprv In Ardsmentioning

confidence: 99%

Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?

Cheng

Dong

et al. 2022

Journal of Intensive Medicine

View full text Add to dashboard Cite

“…Airway pressure release ventilation (APRV) is a mode of mechanical ventilation consisting of the application of continuous positive airway pressure with time-cycled pressure releases [ 1 ]. APRV is widely available on existing ventilators, and has been proposed as an early intervention to prevent lung injury [ 2 ] or as a rescue therapy in the management of refractory hypoxemia [ 3 ]. Some benefits of the approach are associated with the fact that it readily permits the preservation of spontaneous breathing by the patient.…”

Section: Introductionmentioning

confidence: 99%

Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation

et al. 2022

View full text Add to dashboard Cite

Background Airway pressure release ventilation (APRV) is widely available on mechanical ventilators and has been proposed as an early intervention to prevent lung injury or as a rescue therapy in the management of refractory hypoxemia. Driving pressure ($$\Delta P$$ Δ P ) has been identified in numerous studies as a key indicator of ventilator-induced-lung-injury that needs to be carefully controlled. $$\Delta P$$ Δ P delivered by the ventilator in APRV is not directly measurable in dynamic conditions, and there is no “gold standard” method for its estimation. Methods We used a computational simulator matched to data from 90 patients with acute respiratory distress syndrome (ARDS) to evaluate the accuracy of three “at-the-bedside” methods for estimating ventilator $$\Delta P$$ Δ P during APRV. Results Levels of $$\Delta P$$ Δ P delivered by the ventilator in APRV were generally within safe limits, but in some cases exceeded levels specified by protective ventilation strategies. A formula based on estimating the intrinsic positive end expiratory pressure present at the end of the APRV release provided the most accurate estimates of $$\Delta P$$ Δ P . A second formula based on assuming that expiratory flow, volume and pressure decay mono-exponentially, and a third method that requires temporarily switching to volume-controlled ventilation, also provided accurate estimates of true $$\Delta P$$ Δ P . Conclusions Levels of $$\Delta P$$ Δ P delivered by the ventilator during APRV can potentially exceed levels specified by standard protective ventilation strategies, highlighting the need for careful monitoring. Our results show that $$\Delta P$$ Δ P delivered by the ventilator during APRV can be accurately estimated at the bedside using simple formulae that are based on readily available measurements.

show abstract

Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome

Cited by 9 publications

References 25 publications

A narrative review of advanced ventilator modes in the pediatric intensive care unit

A narrative review of advanced ventilator modes in the pediatric intensive care unit

Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?

Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation

Contact Info

Product

Resources

About