Airway Pressure Release Ventilation: A Neonatal Case Series and Review of Current Pediatric Practice

BACKGROUND: The use of airway pressure release ventilation (APRV) in very low birth weight infants is limited. OBJECTIVE: To report the authors' institutional experience and to review the current literature regarding the use of APRV in pediatric populations. METHODS: Neonates <1500 g ventilated using APRV from 2005 to 2006 at McMaster Children's Hospital (Hamilton, Ontario) were retrospectively reviewed. Publications describing APRV in children from 1987 to 2011 were reviewed. RESULTS: Five infants, 24 to 28 weeks' gestational age, were ventilated using APRV. Indications for APRV were refractory hypoxemia (n=3), ventilatory dyssynchrony (n=1) and minimizing sedatives (n=1). All infants appeared to tolerate APRV well with no recorded adverse events. Current pediatric evidence regarding APRV is primarily observational. Published experience reveals that APRV settings in pediatrics often approximate those used in adults, thus deviating from the original guidelines recommended in children. Clinical outcomes, such as oxygenation, ventilation and sedation requirements, are inconsistent. CONCLUSIONS: APRV is primarily used as a rescue ventilation mode in children. Neonatal evidence is limited; however, the present study indicates that APRV is feasible in very low birth weight infants. There are unique considerations when applying this mode in small infants. Further research is necessary to confirm whether APRV is a safe and effective ventilation strategy in this population.