Intensive Care Medicine

, Volume 44, Issue 9, pp 1595–1596 | Cite as

Airway pressure release ventilation in acute respiratory distress syndrome: children are not miniature adults

  • Vijai Williams
  • Suresh Kumar Angurana
  • Muralidharan JayashreeEmail author
  • Yongfang Zhou
  • Yan Kang

Initial correspondence from Drs. Williams, Angurana and Jayashree

Dear Editor,

In a recent article, Zhou et al. [1] 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...




Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interests.


  1. 1.
    Zhou Y, Jin X, Lv Y et al (2017) Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med 43:1648–1659. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bellani G, Laffey JG, Pham T et al (2016) The LUNG SAFE study: a presentation of the prevalence of ARDS according to the Berlin Definition! Crit Care 20(1):268. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lalgudi Ganesan S, Jayashree M, Singhi SC, Bansal A (2018) Airway pressure release ventilation in pediatric acute respiratory distress syndrome: a randomized controlled trial. Am J Respir Crit Care Med. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Vijai Williams
    • 1
  • Suresh Kumar Angurana
    • 1
  • Muralidharan Jayashree
    • 1
    Email author
  • Yongfang Zhou
    • 2
  • Yan Kang
    • 2
  1. 1.Department of Pediatrics, Advanced Pediatrics CentrePostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina

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