Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome.
BACKGROUND
Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be associated with improved outcome. To fulfil this approach, sedation, neuromuscular blocking agents and full mechanical ventilatory support are often used in critical failure of gas exchange.


METHODS
We present a patient who developed multiple organ failure, including severe ARDS, after severe skin injuries and septic shock. Ventilatory strategy consisted of lung protective approach, permissive hypercapnia and prone positioning. Airway pressure release ventilation (APRV) with the patient's superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after application of combined use of APRV and prone positioning.


CONCLUSIONS
APRV and maintenance of patients' spontaneous ventilation is feasible during prone positioning, and this approach may have beneficial synergistic effects on gas exhange in patients with severe acute lung injury.
Varpula
T
T
Department of Anaesthesia, Helsinki University Hospital, Finland. tero.varpula@hus.fi
Pettilä
V
V
Nieminen
H
H
Takkunen
O
O
D000293:Adolescent; D006801:Humans; D008297:Male; D011312:Pressure; D016684:Prone Position; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*