Airway Pressure Release Ventilation: An Alternative Ventilation Mode for Pediatric Acute Hypoxemic Respiratory Failure

Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation. The use of this model of ventilation in pediatrics has been limited. The authors describe their experience with this mode of ventilation in a series of pediatric hypoxemic respiratory failure patients. Three patients with acute hypoxemic respiratory failure (AHRF) were treated with APRV, when oxygenation did not improve with pressure control ventilation (PCV). The mean age of the patients was 5.8 +/- 1.3 months. Fractional oxygen concentration decreased from 0.97 +/- 0.02 for PCV to 0.68 +/- 0.12 for APRV, peak airway pressure fell from 36.6 +/- 11.5 cm H(2)O for PCV to 33.3 +/- 5.7 cm H(2)O for APRV, mean airway pressure increased from 17.9 +/- 5.9 cmH(2)O for PCV to 27 +/- 2.6 cmH(2)O for APRV and release tidal volume increased from 8.3 +/- 1.5 mL/kg for PCV to 13.2 +/- 1.1 mL/kg for APRV after 1 h. APRV may improve oxygenation in pediatric AHRF when conventional mechanical ventilation fails. The APRV modality may provide better oxygenation with lower peak airway pressure.