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Airway pressure release ventilation in children

Lalgudi Ganesan, Saptharishi

Current Opinion in Critical Care: February 2019 - Volume 25 - Issue 1 - p 63–70
doi: 10.1097/MCC.0000000000000575
RESPIRATORY SYSTEM: Edited by Laurent J. Brochard and Tài Pham

Purpose of review In patients with acute respiratory distress syndrome (ARDS), airway pressure release ventilation (APRV) has been purported to have several physiological benefits. This review synthesizes recent research evaluating APRV mode and provides perspectives on the utility of this mode in children with ARDS.

Recent findings Two single-center clinical trials on APRV, one adult and one pediatric, have been published this year. These two trials have not only elicited editorials and letters that highlight some of their strengths and weaknesses but also rekindled debate on several aspects of APRV. Despite their contradicting results, both trials provide significant insights into APRV strategies that work and those that may not. This review places the newer evidence in the context of existing literature and provides a comprehensive analysis of APRV use in children.

Summary There have been significant recent advancements in our understanding of the clinical utility of APRV in children with ARDS. The recent trial highlights the urgent need to evolve a consensus on definition of APRV and identify strategies that work. Pending further research, clinicians should avoid the use of a zero-PLOW Personalized-APRV strategy as a primary ventilation modality in children with moderate–severe ARDS.

Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada

Correspondence to Saptharishi Lalgudi Ganesan, MBBS, MD, DM, Department of Critical Care Medicine, The Hospital for Sick Children; Program in Neurosciences & Mental Health, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Canada. Tel: +1 416 813 2763; e-mail:

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