Application of airway pressure release ventilation in severe pneumonia-related acute respiratory distress syndrome in children

Abstract

Objective To investigate the effects of airway pressure release ventilation (APRV) in children with severe pneumonia-related acute respiratory distress syndrome(ARDS). Methods Ten children suffering severe pneumonia-related ARDS with APRV were included in Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University from March 2011 to October 2014.Ventilation variables, changes of airway pressure and Ramsay scores were collected and compared with that in conventional ventilation (CV). Clinical variables were mea-sured at CV before APRV and at 1, 4, 12, 24 hours after transition to APRV. Results High airway pressure(Phigh) at each time point during APRV was significantly lower than peak airway pressure(Ppeak) or plateau airway pressure(Pplat) in CV[(26.00±2.94) cmH2O(1 cmH2O=0.098 kPa), (24.40±3.34) cmH2O, (23.30±3.46) cmH2O, (23.00±3.80) cmH2O vs (31.80±5.59) cmH2O, P<0.01]. Mean airway pressure(Pmean) at each time point during APRV was significantly higher than that in CV[(23.00±2.86) cmH2O, (21.69±3.12) cmH2O, (20.89±3.31) cmH2O, (20.46±3.48) cmH2O vs (17.50±2.37) cmH2O, P<0.05]. Fraction of inspired oxygen(FiO2) were significantly decreased at 4, 12 and 24 hours after APRV than that in CV[(73.00±22.39)%, (63.50±20.16)%, (63.00±21.11)% vs (88.00±15.49)%, P<0.05]. Ramsay scores were significantly decreased at each time point during after APRV than that in CV[(3.90±0.74) scores, (2.90±0.88) scores, (3.00±1.15) scores, (3.50±0.71) scores vs (4.60±0.52) scores, P<0.05]. Conclusions Compared with CV, APRV had a lower Phigh and FiO2, a higher Pmean and more shallow sedation.APRV may be an effective ventilation mode in children's severe pneumonia-related ARDS. Key words: Airway pressure release ventilation; Child; Acute respiratory distress syndrome; Mechanical ventilation