Palen Mallory, a pediatric intensivist at Duke University, dives into the fascinating world of Airway Pressure Release Ventilation (APRV) for pediatric ARDS. She discusses the physiological rationale behind APRV and its potential benefits for critically ill children. The conversation addresses the challenges clinicians face, including managing unintended extubation and monitoring complications. Mallory also emphasizes the importance of careful patient selection and institutional practices in optimizing care, shedding light on her ongoing research in this field.
34:45
forum Ask episode
web_stories AI Snips
view_agenda Chapters
auto_awesome Transcript
info_circle Episode notes
volunteer_activism ADVICE
Join Multicenter Collaboratives Early
Get involved in multicenter collaboratives early to build connections and gain research opportunities.
Use existing structures to support your airway safety and ventilation research efforts.
insights INSIGHT
How APRV Works Mechanistically
APRV uses a prolonged high CPAP with brief releases to improve oxygenation and CO2 removal.
It allows unrestricted spontaneous breathing, which may increase comfort and ventilatory efficiency compared to SIMV.
insights INSIGHT
APRV Offers Multiple Physiologic Benefits
APRV minimizes lung trauma by maintaining recruitment with fewer inflation-deflation cycles.
It supports spontaneous breathing, reduces sedation needs, and may improve secretion clearance and hemodynamics.
Get the Snipd Podcast app to discover more snips from this episode
By the end of this series, listeners should be able to discuss:
The physiologic rationale supporting the use of airway pressure release ventilation (APRV) in ARDS.
The patient populations most likely to benefit from APRV.
Key published evidence that informs our use of APRV in critical care.
An expert approach to managing a patient with APRV.
Next steps in research that will direct our understanding of the use of APRV in pediatric critical care.
About our Guest:
Dr. Palen Mallory is an assistant professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. She completed medical school at Virginia Commonwealth University, a pediatric residency at Emory University, and a critical care fellowship at Vanderbilt University. She is interested in respiratory care research, including ECMO, respiratory failure, and ARDS.
Selected References:
Mallory, P., & Cheifetz, I. (2020). A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Review of Respiratory Medicine, 14(3), 307–315. https://doi.org/10.1080/17476348.2020.1708719
Frawley, P. M., & Habashi, N. M. (2004). Airway pressure release ventilation and pediatrics: Theory and practice. Critical Care Nursing Clinics of North America, 16(3 SPEC. ISS.), 337–348. https://doi.org/10.1016/J.CCELL.2004.04.003
Fredericks, A. S., Bunker, M. P., Gliga, L. A., Ebeling, C. G., Ringqvist, J. R. B., Heravi, H., Manley, J., Valladares, J., & Romito, B. T. (2020). Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 14. https://doi.org/10.1177/1179548420903297
Andrews P, Shiber J, Madden M, Nieman GF, Camporota L, Habashi NM. Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal. Front Physiol. 2022 Jul 25;13:928562. doi: 10.3389/fphys.2022.928562. PMID: 35957
How to support PedsCrit: Please complete our Listener Feedback Survey Please rate and review on Spotify and Apple Podcasts! Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.
Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
PedsCrit