Airway pressure release ventilation in acute respiratory distress syndrome: children are not miniature adults
Initial correspondence from Drs. Williams, Angurana and Jayashree
In a recent article, Zhou et al.  found early application of airway pressure release ventilation (APRV) in adults with acute respiratory distress syndrome (ARDS) (n = 138) led to more ventilation-free days, better respiratory compliance, improved gas exchange, shorter ICU stays, and lower mortality (19.7% vs. 34.3%) than in a low tidal volume (LTV) group. In this context, we would like to make a few important observations.
The LTV group had a higher incidence of ARDS caused by pneumonia and a higher proportion of patients (50.7% vs. 32.4%) with comorbidities (COPD, renal dysfunction and malignancy) and vasopressor requirement (68.7% vs. 56.3%). We believe these factors rather than the ventilation mode per se could have contributed to the poor outcomes in the LTV group. Furthermore, the higher incidence of tracheostomy (29.9% vs. 12.7%) and need for sedation in the LTV compared with the APRV group also...
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Conflicts of interest
The authors declare that they have no conflict of interests.