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 Airway Pressure Release Ventilation (APRV) in a pediatric burn patient complicated by Inhalation Injury and Acute Respiratory Distress Syndrome.Carman B, RRT, Cahill T, RRT, Berwanger M, BSN, RRT, Meyer N, MD, Warden G, MD, FACS, McCall J, MD BACKGROUND: Airway pressure release ventilation (APRV) is a mode of mechanical ventilation, which allows unrestricted spontaneous breathing throughout the breathing cycle. APRV is consistent with a lung protective strategy of ventilation that attempts to limit lung injury associated with mechanical ventilation. APRV has been used successfully in the adult patient population, but not extensively in the pediatric burn patient population. CASE REPORT: A 5 year old child with acute respiratory distress syndrome (ARDS) secondary to 90% TBSA burn with severe inhalation injury developed respiratory failure which was refractory to conventional ventilation strategies as evidenced by PaCO2 57 and PaO2 70. Nitric Oxide (NO) therapy with permissive hypercapnia was initiated but oxygenation did not improve. APRV was initiated 24 hours later. Spontaneous breathing during APRV resulted in improved oxygenation with PaO2 increased to 118. The patient was weaned from mechanical ventilation over time. Follow up pulmonary function testing demonstrated no adverse long-term effects of the ventilation strategy employed, or from ARDS or inhalation injury. CONCLUSION: APRV, which allows spontaneous breathing by the patient, combined with NO therapy, can be a safe and effective for the treatment of inhalation injury complicated by ARDS refractory to conventional modes of ventilation. |
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