APRV in Kids: The Good the Bad and the Ugly

This is a case-based discussion on how to use APRV in children. Cases include a near-drowning patient with ARDS and a patient with Glenn single ventricle physiology with bronchiolitis. This talk will discuss clinical indications for APRV during transport and how APRV works physiologically. Case-based presentations will guide the learner on how to transition from traditional modes of ventilation to APRV, how to pick initial settings, and how to titrate settings in addition to what hemodynamic and ventilator waveforms to monitor during the transition.
A brief overview of cardiopulmonary interactions using APRV as a ventilation strategy will also be discussed. This will include review of a paper describing the hemodynamic changes associated with APRV compared to conventional ventilation in pediatric patients with right ventricular dysfunction and/or Cavo pulmonary shunts such as the Glenn and Fontan circuit. This talk will also discuss some of the risk and difficulties with APRV, especially in younger patient populations.