1159

Abstract

Introduction: Acute respiratory failure (ARF) is one of the most common causes for admission to pediatric intensive care units. Children who have reversible lung disease with life threatening hypoxia or hypercarbia are candidates for extracorporeal membrane oxygenation, (ECMO) which ensures gas exchange while limiting ventilator induced injury. The ventilator is often put on rest settings which can lead to pulmonary derecruitment. High pressure recruitment efforts are needed before separation from ECMO. Airway Pressure Release Ventilation (APRV) can promote lung recruitment and maintenance of functional residual capacity (FRC), preparing the lungs for resumption of function after separation from ECMO. We propose that APRV can be used for lung recruitment and maintenance or aeration in non-spontaneous breathing children on ECMO for ARF. Here we report 3 children with ARF requiring VA ECMO who had radiologic and physiologic evidence of derecruitment on rest settings. APRV was able to provide recruitment on CXR. Patient 1: 6 week old male with pertussis requiring ECMO had peak inspiratory pressure (PIP) 26 cm H2O resulting in effective tidal volume (Vteff) 2 mL/kg after 22 days on ECMO. He was on APRV for 7 days; subsequently on PC he had a PIP 30 cm H2O and Vteff 8mL/kg. He was decannulated on ECMO day 29. Patient 2: 5 year old male with group A strep sepsis and pulmonary hemorrhage who required 9 days of ECMO. Initially on ECMO with pressure control (PC) ventilation he had Vteff of 2 mL/kg with PIP 22 cm H2O. After recruitment with APRV he resumed PC and with Vteff 6 mL/kg and PIP 22 cm H2O. Patient 3: 28 month old female with a history of heart transplant and ARF due to RSV who had 13 days of ECMO. The patient was on PC with Vteff 1.7 mL/kg and PIP 20 cm H2O before APRV. Before separation from ECMO she was transitioned from APRV to PC and was receiving 7 mL/kg TV with PIP 30 cm H2O. This novel use of APRV in non-spontaneously breathing children with ARF requiring ECMO facilitated pulmonary recruitment and separation from ECMO. There were no adverse events related to APRV. More research is needed to determine the best methods of ventilation in patients with ARF on ECMO.