Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Curr Opin Crit Care. 2019 Feb;25(1):63-70. doi: 10.1097/MCC.0000000000000575.
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.
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.
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.
在急性呼吸窘迫综合征（ARDS）患者中，气道压力释放通气（APRV）据称具有多种生理益处。本综述综合了最近评估 APRV 模式的研究，并对该模式在 ARDS 儿童中的应用提供了一些观点。
今年发表了两项关于 APRV 的单中心临床试验，一项是成人的，另一项是儿科的。这两项试验不仅引起了社论和信件的关注，强调了它们的一些优点和缺点，而且重新引发了关于 APRV 几个方面的争论。尽管这两项试验的结果相互矛盾，但它们都为 APRV 的有效策略提供了重要的见解。本综述将新的证据置于现有文献的背景下，并对 APRV 在儿童中的应用进行了全面分析。
最近我们对 APRV 在 ARDS 儿童中的临床应用有了重大的认识进展。最近的试验强调了迫切需要就 APRV 的定义和确定有效的策略达成共识。在进一步的研究之前，临床医生应避免将零压力个体化 APRV 策略作为中重度 ARDS 儿童的主要通气模式。
