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HOME > Acute Crit Care > Volume 40(1); 2025 > Article
Original Article
Pediatrics Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India
Sudha Chandelia1orcid, Sunil Kishore1orcid, Maansi Gangwal1orcid, Devika Shanmugasundaram2orcid
Acute and Critical Care 2025;40(1):113-121.
DOI: https://doi.org/10.4266/acc.002520
Published online: February 28, 2025

1Division of Pediatric Critical Care, Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER), Dr. Ram Manohar Lohia Hospital, New Delhi, India

2Department of Biostatistics, Christian Medical College, Vellore, India

Corresponding author: Sudha Chandelia Division of Pediatric Critical Care, Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences (formerly PGIMER), Dr. Ram Manohar Lohia Hospital, 403, PGI building, Admin block, Delhi 110001, India Tel: +91-11-2340-4784 Fax: +91-11-2336-5550 Email: sudhach83@rediffmail.com
• Received: May 31, 2024   • Revised: November 8, 2024   • Accepted: January 20, 2025

© 2025 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background:
    Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
  • Methods:
    This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
  • Results:
    A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
  • Conclusions:
    Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.
  • Key Words: airway pressure release ventilation; mechanical ventilation; mortality; pediatric acute respiratory distress syndrome; pediatric intensive care unit
Pediatric acute respiratory distress syndrome (PARDS) is an alarming complication in hospitalized children, affecting approximately 4%–10% of pediatric intensive care unit (PICU) admissions [1-4]. PARDS complicates many critical illnesses and has a high mortality of up to 75% in some regions [5]; mortality can be as high as 90% in severe PARDS [6]. Supportive care in the form of mechanical ventilation remains the keystone therapy. In 2001, ARDSnet recommended using lower tidal ventilation and titrating high positive end expiratory pressure (PEEP) levels to reduce mortality in adults [7]. Since then, this approach has become the standard of care for adult acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). However, studies in the post low tidal volume ventilation era showed that mortality of ARDS remains very high, up to 50%, even when using protective ventilation [8,9]. Moreover, this protective ventilation approach has not been tested in children. The PARDS/Pediatric Acute Lung Injury Consensus Conference consensus also did not recommend use of one ventilation mode over the other due to a lack of data [10]. Thus, there is need to define the most efficacious ventilation mode in PARDS. One such mode may be airway pressure release ventilation (APRV). It was first described in 1987 by Stock and Downs and has been shown to improve oxygenation in various populations of patients [11]. Some case reports have shown APRV to be beneficial in ALI/ARDS in children but those are sparse [12-20]. Furthermore, no randomized controlled trials (RCTs) have compared APRV mode with other ventilation modes in severe PARDS. In this retrospective study we evaluated the effects of APRV in the treatment of severe PARDS compared with other modes of ventilation.
The study was approved by the Institutional Ethics Committee of Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital (No. 140(9/2016)/IEC/PGIMER/RMLH). Written informed consent was not applicable as this study collected data retrospectively.
Study Design and Hypothesis
The study was conducted in an 18-bed pediatric ICU of a university-affiliated tertiary-care hospital in Delhi, India. This single-center retrospective study used case files of PICU admissions. We evaluated whether APRV mode decreased mortality in severe PARDS in comparison to other ventilator modes. In our PICU, various modes are used for ARDS including biphasic positive airway pressure (BIPAP), pressure-controlled ventilation (PCV) and synchronized intermittent mandatory ventilation-volume (SIMV-V). We use a tidal volume of 6 ml/kg. Initially FiO2 is kept at 100% and PEEP is increased every 10–15 minutes until the patient achieves SpO2 of 88%–92% and best compliance. Attempts are made frequently to reduce FiO2 to 60%–70%. APRV mode came in use during 2017 using the Evita-4 ventilator (Drager). We started using APRV mode due to: (1) the theoretical advantage of better alveolar recruitment; (2) available case reports favoring it in children; and (3) high mortality resulting from PARDS on previous/existing modes of ventilation. The APRV mode was used when patients failed to maintain oxygenation on routine ventilation (rescue treatment).
All patients with severe PARDS during 2017–2019 received APRV and constituted the APRV group. Patients with severe PARDS receiving other modes of ventilation before 2017 were considered the non-APRV group. Non-APRV patients were matched to the APRV group with respect to (1) a PaO2/FiO2 ratio (P/F ratio) less than 100 after initial stabilization and on mechanical ventilation, (2) a PEEP of at least 10 mbar required for initial stabilization.
APRV Mode
APRV mode uses two levels of continuous pressure, a higher pressure level (PHigh) and a lower pressure level (PLow). The time for which higher pressure is maintained is THigh and this along with PHigh improves oxygenation. Higher pressure is released briefly to lower pressure level for ventilation. The brief time during which pressure is released is TLow. It was our practice to start a PHigh of 25 mbar and gradually increase it by 2 mbar every 10-15 minutes until saturation reached 88%–92%. Mostly we used PHigh up to 35 mbar. We set PLow at 0 mbar, THigh at 4 seconds, and TLow at 0.3 seconds. We increased THigh up to 6-7 seconds to maintain SpO2 in range of 88%–92%. We titrated TLow to achieve end expiratory flow between 50%–75% peak expiratory pressure; in our patients, it ranged between 0.2 and 0.5 seconds but mostly it was 0.3–0.4 seconds. For weaning we increased THigh and decreased PHigh (drop and stretch technique). We did not give any sedation or neuromuscular blocks when using APRV.
Study Population and Setting
The study sample included all case files of mechanically ventilated patients in the age range 1 month to 14 years, with a final diagnosis of severe ARDS (P/F ratio <100; Berlin definition) [21]. These included all patients admitted with severe ARDS or developing severe ARDS in PICU where the duration of ARDS was documented to be within 7 days. We excluded patients with brain death, terminal cancer, immunodeficiency, chronic lung disease, heart disease, patients with raised intracranial tension, Glasgow Coma Scale (GCS) below 8, diaphragmatic paralysis/hernia, and/or metabolic or neuromuscular disease.
Sampling Technique
Both groups were selected using a consecutive sampling technique. First we screened all cases with a diagnosis of ARDS; from these, severe ARDS cases without comorbidities were chosen for inclusion. A total of 24 patients were enrolled in the APRV group, so we screened records in the non-APRV group until we enrolled an equal number of cases with adequate data.
Study Outcomes
The primary outcome was all-cause in-hospital mortality. Secondary outcomes were oxygenation status (P/F ratio), ventilator parameters and adverse effects. The dependent outcome was mortality and independent outcomes were age, sex, P/F ratio, duration of hypoxemia and lung injury score (LIS) because these may affect mortality.
Data Collection and Abstraction Instrument
Two senior residents performed data abstraction and collection from the case files. They were made familiar with the case files and instructed to remain objective. They were trained with the data abstraction instrument. The data were recorded on a pre-designed Performa. Any conflicting data were sorted by discussion among the investigators. Data on age, sex, pediatric logistic organ dysfunction (PELOD) score, duration of hypoxemia before implementation of ventilation, LIS, arterial blood gas, ventilation monitoring parameters, presence of shock, multiple organ dysfunction syndrome, GCS, chest x-ray findings, pulmonary or extra-pulmonary etiology and mortality in both groups were collected. All variables were entered and stored in an excel file and a code book was prepared for statistical analysis. All variables were chosen a priori based on clinical reasoning.
Blinding
The data abstractors and analyst were blinded to the aim, hypothesis and outcomes of the study.
Statistical Analysis
Statistical analysis was done using R language and R Studio software for statistical computing and SPSS version 23 (IBM Corp.). The study population was described using descriptive statistics. Categorical variables are presented as counts and frequencies and continuous variables as means with standard deviation or median with interquartile range (IQR), depending on the normality of the data. The survival time in both groups was compared using log-rank test. Kaplan-Meier curves were plotted to show the survival probability in both groups. Cox proportional hazards analysis was performed to calculate hazard ratio (HR). Analysis of variance test was applied to study the difference in P/F ratio at multiple time points. All P-values were considered significant at <0.05.
A total of 48 children were selected during screening (24 patients in each group) (Figure 1). At the beginning of mechanical ventilation, various modes were used, including SIMV-V, BIPAP and PCV, and their sequence is presented in Figure 2. The final mode was PCV in the non-APRV group. Sedation and neuromuscular blockers were used in only the non-APRV group. None of the patients was put in the prone position or underwent extracorporeal membrane oxygenation (ECMO). Demographic data and patient baseline characteristics are shown in Table 1. The P/F ratios were lower and LIS was higher in the APRV group. Similarly, the duration of severe ARDS state was longer in the APRV group. Other baseline factors were similar in both groups.
Primary Outcome
Overall in-hospital mortality in the APRV group was 79% vs. 91% in the non-APRV group. Use of APRV mode was associated with lower risk of mortality in unadjusted analysis (HR, 0.27; 95% CI, 0.14–0.52; P=0.001) (Table 2). When adjusted for age, sex, baseline PELODS severity score, baseline P/F ratio, LIS and duration of hypoxia before ventilation mode, the adjusted HR (95% CI) was 0.03 (0.005–0.17) (P=0.001). The only covariate significantly associated with mortality in this model was severity of illness score (HR, 1.05; 95% CI, 1.01–1.10; P=0.009). P/F ratio and LIS may be correlated; thus, we did not included LIS in multiple logistic regression.
Survival Analysis
As mortality in severe PARDS was high, we performed survival analysis in these patients. The median time spent on APRV was 7.5 days (IQR, 5.5–7.8 days) as compared to 4.3 days (IQR, 3.9–4.8 days). The survival time was calculated from the beginning of mechanical ventilation (time at which any initial mode was tried in both treatment groups). The survival time in the APRV group was significantly longer compared with the non-APRV group (P=0.001). Kaplan-Meier curve (Figure 3) showed better survival probability and times in patients receiving APRV mode.
Secondary Outcome
In the APRV group the baseline P/F ratios were lower than non-APRV group (mean±standard deviation [SD], 67.21±9.74 vs. 91.65±8.68). Initially (at 1–12 hours), a rise in P/F ratio occurred in both groups and was greater in the non-APRV group (Figure 4). After 24 hours, the APRV group had a better P/F ratio, but this was not statistically significant (P=0.16). Later in the course, P/F ratios worsened in both treatment groups, with high mortality in both groups. Other parameters such as mean airway pressure, tidal volume and compliance showed similar patterns. Therefore, these parameters cannot be used to compare both groups as whole. If there had been more survivors it would have been useful to perform subgroup analysis with these parameters.
Safety
APRV mode was relatively safe. None of the patients developed pneumothorax on APRV while three children developed pneumothorax in other modes. Three surviving patients were already on inotrope vasoactive medications before application of APRV.
In this single-center retrospective analytic study of effect of rescue APRV mode on mortality in severe PARDS, the use of APRV mode was associated with decreased risk of mortality, better P/F ratios at 24 hours and longer survival times. APRV mode stabilized oxygenation in patients in whom conventional and lung-protective ventilation had failed. APRV sustained target SpO2 for a longer period before the final outcome. This is despite of the fact that P/F ratios were lower and LIS were higher in the APRV group. Similarly, the duration of severe ARDS state was longer in the APRV group. Hence, the risk of mortality was higher in patients in the APRV group due to their poorer clinical/laboratory parameters [22-24]. Almost all studies have shown better oxygenation with APRV but these studies had better baseline P/F ratios than our study population [15,19,25-29]. The lower P/F ratio may be responsible for overall high mortality in both groups. Longer survival time with better oxygenation levels may allow the intensivists to arrange for higher treatment options such as ECMO and lung transplant.
Initially, a rise in P/F ratio occurred in both groups and was better in the non-APRV group. This may be due to early disease responding to routine mechanical ventilation in the non-APRV group (applied earlier in the course of disease). It also may be attributed to better baseline P/F ratio in the non-APRV group. APRV was instituted late in the course of the disease. However further observations showed that the APRV group had better P/F ratios. We hypothesize that if APRV was used earlier in the course of disease, the results would be more favorable. A study in adults that applied APRV earlier, showed that the duration of both mechanical ventilation and ventilation-free days was better in the APRV group [25]. A recent meta-analysis showed APRV to be safe and effective in adult ARDS [29].
APRV appears promising because of its unique mechanism of action on alveolar recruitment. Patients with ARDS have adequate respiratory drive, respiratory muscle strength and respiratory rate. In spite of this, they have hypoxemia due to collapse of alveoli and thickened alveolar-capillary membranes preventing diffusion. APRV uses a baseline high inspiratory pressure for a longer duration than conventional pressure control mode and then suddenly releases pressure to zero for a very short duration necessary for tidal ventilation. Thus, it can achieve higher MAP while keeping peak pressure low.
Furthermore, APRV mode has been shown to reduce ventilator-induced lung injury (VILI) in animal studies when compared to low TV and high TV. When APRV applied early in the disease course, it prevented lung injury by preserving lung E-cadherin and surfactant protein A. It can thus attenuate lung permeability, edema and surfactant degradation [30]. The literature showed that APRV mode is associated with higher tidal volumes, and we also observed that TV was higher, up to 12 ml/kg, but human data still showed it to be beneficial for
survival. This means there may be more mechanisms associated with VILI.
In our study, we noted few complications after its initiation. Hypercapnia was recorded without pH change. Shock, renal function and air leaks were not associated with APRV. One pediatric RCT tested APRV in PARDS compared with a low tidal volume strategy. Although the primary outcome of this trial was 28-day ventilator-free days, on interim analysis mortality was observed to be much higher in the APRV group (53.8%) as compared to low tidal volume (LTV) approach (26.9%). The reason could be higher proportion of severe PARDS in the APRV group and similar sedation doses used in the APRV group as used in LTV group [31].
These results are reliable as we took all consecutive patients in the APRV era. The APRV group received APRV after failing conventional ventilation. This avoided bias regarding the patient’s caregivers/doctors selecting procedures. We can say that patients received APRV regardless of their mortality risk. To some extent this preserves internal validity. Secondly, blinding was done at the level of data abstraction and outcome assessment. This step also reduced bias in the results. Thirdly, comparison with a control group reduces any chance of temporal association due to the natural course of ARDS. In the APRV group, APRV mode was used approximately 12 hours after conventional ventilation and showed better oxygenation.
There are several limitations to this study. Firstly, because the study is a retrospective study analyzing data already collected, we had no control over patient selection, stratification, and treatment allocation. Secondly we could not take concurrent controls because all patients received APRV after failing other ventilation modes after 2017. Despite above limitations, the present study is important for two reasons. One, most centers have reported a mortality of 35% in ARDS and even higher in certain risk tertiles and severe ARDS categories. Designing a RCT with a target reduction in mortality to half proportion would require a larger sample size. This may not be feasible given the low incidence of the disease in children, which is currently at 4%–10% [1-4]. Second, there are issues implementing the recommended protective ventilation strategy described by some authors. We also faced this problem [32,33]. Intensivists may not find it feasible to make protective ventilation the control arm in prospective studies. Also, we used LIS to compare baseline lung state, but this has not been validated in a pediatric population.
APRV despite being a newer mode showed promising results. Knowledge has definitely improved with time and in the future we may see better results. Furthermore, we applied APRV very late in the course of the disease, which may be a reason for its failure in many cases. Many studies have shown that when the lung becomes unrecruitable, nothing works. Aggressive management is usually late in terms of different ventilation modes and ancillary treatments. From our experience, we expected a higher mortality if protective ventilation was allowed to continue. Thus, this study will help in designing future studies in severe PARDS.
There may be many more factors affecting mortality that we could not take into account, so it is impossible to exclude the potential contribution of these factors to the improvement in survival. We found APRV beneficial in correcting oxygenation rapidly in children. As oxygenation improves, it raises new hope for patient survival. This prompted us to use it in all patients as a rescue measure. However, the results of this study should be interpreted carefully in view of sparse data where there were few events in both intervention groups resulting in low risk ratios. Use of APRV mode in severe PARDS may reduce the risk of in-hospital mortality and may increase survival time.
▪ Severe pediatric acute respiratory distress syndrome is associated with high mortality, up to 75%.
▪ Use of airway pressure release ventilation mode as rescue ventilation strategy may reduce mortality and increase survival time in severe pediatric acute respiratory distress syndrome.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

Conceptualization: SC. Data curation: SK, MG. Formal analysis: SC, DS. Methodology: SC. Writing – original draft: SC. Writing – review & editing: all authors. All authors read and agreed to the published version of the manuscript.

Figure 1.
Flowchart of included participants. ARDS: acute respiratory distress syndrome; PARDS: pediatric acute respiratory distress syndrome; P/F ratio: PaO2/FiO2 ratio; APRV: airway pressure release ventilation. a) After we got 24 children in APRV, we screened records in non-APRV group till we got an equal number of similar cases with adequate data.
acc-002520f1.jpg
Figure 2.
Ventilation modes used in all patients in sequence. PCV: pressure-controlled ventilation; SIMV-V: synchronized intermittent mandatory ventilation-volume; APRV: airway pressure release ventilation; BIPAP: biphasic intermittent positive airway pressure.
acc-002520f2.jpg
Figure 3.
Kaplan-Meier curve showing survival probabilities in the two ventilator modes. APRV: airway pressure release ventilation.
acc-002520f3.jpg
Figure 4.
Comparison of PaO2 /FiO2 ratio (P/F ratio) between the two groups over the first 24 hours of instituting the study ventilation mode. APRV: airway pressure release ventilation.
acc-002520f4.jpg
Table 1.
Demographic and baseline parameters of patients in both groups
Variable APRV group Non-APRV group
Total patients 24 24
Age (yr) 8±4 8±4
Male:female 1:2 1:1.18
P/F ratio baseline 66.0±9.0 91.7±8.7
PEEP (mbar) 14 10
PELOD 26.9±8.3 24.7±7.0
Lung injury score 3.5±0.3 2.6±0.4
Duration of P/F ratio <100 mm Hg (hr)a) 15.8±5.9 0.6±0.2
Etiology
 Pneumonia 15 17
 Sepsis 7 6
 Malaria 1 0
 Scrub typhus 1 0
 Burns 0 1

Values are presented as mean±standard deviation.

APRV: airway pressure release ventilation; P/F ratio: PaO2 /FiO2 ratio; PEEP: positive end expiratory pressure; PELOD: pediatric logistic organ dysfunction score.

a)Duration before implementation of any mechanical ventilation mode.

Table 2.
Multivariable model ICU mortality as the outcome of severe ARDS patients
Variable Univariate analysis
 Multivariate analysis
HR 95% CI P-value HR 95% CI P-value
APRV ventilation 0.27 0.14–0.52 0.001 0.03 0.005–0.17 0.001
Age 0.98 0.90–1.06 0.61 0.99 0.91–1.10 1.10
Sex female (referent) 1.31 0.70–2.44 0.39 0.96 0.48–1.96 0.91
PELODS 1.04 0.99–1.07 0.06 1.05 1.01–1.10 0.01
P/F ratio baseline 1.02 0.99–1.04 0.08 0.97 0.93–1.01 0.28
Duration of P/F ratio <100 mm Hg (hr)a) 0.95 0.91–0.99 0.02 1.06 0.97–1.15 0.17
Lung injury score 0.57 0.28–1.17 0.12 - - -

ICU: intensive care unit; ARDS: acute respiratory distress syndrome; HR: hazard ratio; APRV: airway pressure release ventilation; PELOD: pediatric logistic organ dysfunction score; P/F ratio: PaO2/FiO2 ratio.

a)Duration before implementation of any mechanical ventilation mode.

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        Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India
        Acute Crit Care. 2025;40(1):113-121.   Published online February 28, 2025
        DOI: https://doi.org/10.4266/acc.002520
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      Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India
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      Figure 1. Flowchart of included participants. ARDS: acute respiratory distress syndrome; PARDS: pediatric acute respiratory distress syndrome; P/F ratio: PaO2/FiO2 ratio; APRV: airway pressure release ventilation. a) After we got 24 children in APRV, we screened records in non-APRV group till we got an equal number of similar cases with adequate data.
      Figure 2. Ventilation modes used in all patients in sequence. PCV: pressure-controlled ventilation; SIMV-V: synchronized intermittent mandatory ventilation-volume; APRV: airway pressure release ventilation; BIPAP: biphasic intermittent positive airway pressure.
      Figure 3. Kaplan-Meier curve showing survival probabilities in the two ventilator modes. APRV: airway pressure release ventilation.
      Figure 4. Comparison of PaO2 /FiO2 ratio (P/F ratio) between the two groups over the first 24 hours of instituting the study ventilation mode. APRV: airway pressure release ventilation.

      Figure 1.

      Figure 2.

      Figure 3.

      Figure 4.

      Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India
      Variable APRV group Non-APRV group
      Total patients 24 24
      Age (yr) 8±4 8±4
      Male:female 1:2 1:1.18
      P/F ratio baseline 66.0±9.0 91.7±8.7
      PEEP (mbar) 14 10
      PELOD 26.9±8.3 24.7±7.0
      Lung injury score 3.5±0.3 2.6±0.4
      Duration of P/F ratio <100 mm Hg (hr)a) 15.8±5.9 0.6±0.2
      Etiology
       Pneumonia 15 17
       Sepsis 7 6
       Malaria 1 0
       Scrub typhus 1 0
       Burns 0 1
      Variable Univariate analysis
      		 Multivariate analysis
      HR 95% CI P-value HR 95% CI P-value
      APRV ventilation 0.27 0.14–0.52 0.001 0.03 0.005–0.17 0.001
      Age 0.98 0.90–1.06 0.61 0.99 0.91–1.10 1.10
      Sex female (referent) 1.31 0.70–2.44 0.39 0.96 0.48–1.96 0.91
      PELODS 1.04 0.99–1.07 0.06 1.05 1.01–1.10 0.01
      P/F ratio baseline 1.02 0.99–1.04 0.08 0.97 0.93–1.01 0.28
      Duration of P/F ratio <100 mm Hg (hr)a) 0.95 0.91–0.99 0.02 1.06 0.97–1.15 0.17
      Lung injury score 0.57 0.28–1.17 0.12 - - -
      Table 1. Demographic and baseline parameters of patients in both groups

      Values are presented as mean±standard deviation.

      APRV: airway pressure release ventilation; P/F ratio: PaO2 /FiO2 ratio; PEEP: positive end expiratory pressure; PELOD: pediatric logistic organ dysfunction score.

      Duration before implementation of any mechanical ventilation mode.

      Table 2. Multivariable model ICU mortality as the outcome of severe ARDS patients

      ICU: intensive care unit; ARDS: acute respiratory distress syndrome; HR: hazard ratio; APRV: airway pressure release ventilation; PELOD: pediatric logistic organ dysfunction score; P/F ratio: PaO2/FiO2 ratio.

      Duration before implementation of any mechanical ventilation mode.

      Table 1.

      Table 2.

      ACC : Acute and Critical Care
      © The Korean Society of Critical Care Medicine.
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