Abstract
Only a few studies have reported pediatric acute respiratory distress syndrome (ARDS) managed with airway pressure release ventilation (APRV). Unlike in adults, the ARDS Clinical Practice Guideline 2021 does not recommend APRV in children. Herein, we report a case of a pediatric ARDS successfully managed with APRV. The patient was a 6-year-old girl who had been treated for Miller–Dieker syndrome and other conditions at our hospital. She was admitted due to pneumonia caused by respiratory syncytial virus, which occurred while receiving home mechanical ventilation with a tracheostomy. Hypoxemia progressed. On hospital day 7, despite being on pressure-controlled synchronized intermittent mandatory ventilation with a positive end-expiratory pressure of 15 cmH2O, the pulse oximetry saturation/fractional inspired oxygen (S/F) ratio decreased to 79. Following the switch to APRV mode (inspiratory pressure Phigh): 45 cmH2O, expiratory pressure Plow): 0 cmH2O, inspiratory time Thigh): 1.5 sec, expiratory time Tlow): 0.5 sec, auto-release: 75%), the S/F ratio increased to 116, and the patient responded to treatment. On hospital day 56, she was placed on the spontaneous/timed mode (inspiratory positive airway pressure: 17 cmH2O and expiratory positive airway pressure: 8 cmH2O) and was eventually discharged home. APRV may be considered as a rescue mode for pediatric ARDS cases resistant to conventional mechanical ventilation.
