Trial reportAmerican journal of respiratory and critical care medicine2018
Airway Pressure Release Ventilation in Pediatric Acute Respiratory Distress Syndrome. A Randomized Controlled Trial.
Trial report in American journal of respiratory and critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02167698 (A Parallel-arm, Single Blind Randomised Controlled Trial Comparing 'AIRWAY PRESSURE RELEASE VENTILATION' and 'LOW-TIDAL VOLUME VENTILATION' in Children With Acute Respiratory Distress Syndrome), which is not on this map. Cited by 35 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Parallel-arm, Single Blind Randomised Controlled Trial Comparing 'AIRWAY PRESSURE RELEASE VENTILATION' and 'LOW-TIDAL VOLUME VENTILATION' in Children With Acute Respiratory Distress Syndrome
Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 95 citations in OpenAlex.
- Time-controlled adaptive ventilation in patients with ARDS-lack of protocol adherence: a systematic review.Critical care (London, England) · 2023Pooled it
- Randomized Feasibility Trial of a Low Tidal Volume-Airway Pressure Release Ventilation Protocol Compared With Traditional Airway Pressure Release Ventilation and Volume Control Ventilation Protocols.Critical care medicine · 2018Trial
- Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India.Acute and critical care · 2025Article
- A Master Protocol Template for Pediatric ARDS Studies.Respiratory care · 2024Article
- Invasive Mechanical Ventilation.Critical care clinics · 2024Review
- Successful application of airway pressure release ventilation in a child with severe acute respiratory distress syndrome induced by trauma: a case report.BMC pulmonary medicine · 2024Article
- First Stabilize and then Gradually Recruit: A Paradigm Shift in Protective Mechanical Ventilation for Acute Lung Injury.Journal of clinical medicine · 2023Review
- Does airway pressure release ventilation offer new hope for treating acute respiratory distress syndrome?Journal of intensive medicine · 2022Review
- Development of a Standardized Clinical Assessment and Management Plan for Pediatric Acute Respiratory Distress Syndrome.Journal of pediatric intensive care · 2022Article
- ARDS Clinical Practice Guideline 2021.Journal of intensive care · 2022Article
- Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal.Frontiers in physiology · 2022Review
- Comparison of Airway Pressure Release Ventilation to High-Frequency Oscillatory Ventilation in Neonates with Refractory Respiratory Failure.International journal of pediatrics · 2022Article
- A narrative review of advanced ventilator modes in the pediatric intensive care unit.Translational pediatrics · 2021Review
- Mechanical Ventilation in Pediatric and Neonatal Patients.Frontiers in physiology · 2021Review
- Impact of positive biphasic pressure during low and high inspiratory efforts in Pseudomonas aeruginosa-induced pneumonia.PloS one · 2021Article
- Highlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference.ERJ open research · 2021Review
- Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome.Current anesthesiology reports · 2021Review
- Current and evolving standards of care for patients with ARDS.Intensive care medicine · 2020Review
- Myorelaxants in ARDS patients.Intensive care medicine · 2020Review
- Airway Pressure Release Ventilation as a Rescue Therapy in Pediatric Acute Respiratory Distress Syndrome (pARDS): Goodwill or Devil?Indian journal of pediatrics · 2020Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleAlthough case series describe benefits of airway pressure release ventilation (APRV), this mode of ventilation has not been evaluated against the conventional low-tidal volume ventilation (LoTV) in children with acute respiratory distress syndrome (ARDS).
objectivesTo compare the effect of APRV and conventional LoTV on ventilator-free days in children with ARDS.
methodsThis open-label, parallel-design randomized controlled trial was conducted in a 15-bed ICU. Children aged 1 month to 12 years satisfying the modified Berlin definition were included. We excluded children with air leaks, increased intracranial pressure, poor spontaneous breathing efforts, chronic lung disease, and beyond 24 hours of ARDS diagnosis or 72 hours of ventilation. Children were randomized using unstratified, variable-sized block technique. A priori interim analysis was planned at 50% enrollment. All enrolled children were followed up until 180 days after enrollment or death, whichever was earlier. MEASUREMENTS AND MAIN
resultsThe trial was terminated after 50% enrollment (52 children) when analysis revealed higher mortality in the intervention arm. Ventilator-free days were statistically similar in both arms (P = 0.23). The 28-day all-cause mortality was 53.8% in APRV as compared with 26.9% among control subjects (risk ratio, 2.0; 95% confidence interval, 0.97-4.1; Fisher exact P = 0.089). The multivariate-adjusted risk ratio of death for APRV compared with LoTV was 2.02 (95% confidence interval, 0.99-4.12; P = 0.05). Higher mean airway pressures, greater spontaneous breathing, and early improvement in oxygenation were seen in the intervention arm.
conclusionsAPRV, as a primary ventilation strategy in children with ARDS, was associated with a trend toward higher mortality compared with the conventional LoTV. Limitations should be considered while interpreting these results. Clinical trial registered with www.clinicaltrials.gov (NCT02167698) and Clinical Trials Registry of India (CTRI/2014/06/004677).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.