Airway pressure release ventilation as a recruitment maneuver in mechanically ventilated children with restrictive lung disease.

Rationale: Restrictive lung disease is common in pediatric patients, leading to acute-on-chronic respiratory failure and the need for invasive mechanical ventilation. There is no consensus on lung recruitment maneuvers. Objectives: To examine the use of airway pressure release ventilation (APRV) in patients with restrictive lung disease as an effective open-lung tool maneuver. Methods: This single-center retrospective case series included patients with restrictive lung disease in a 28-bed pediatric intensive care unit from 2013 to 2024, who developed acute-on-chronic respiratory failure requiring invasive mechanical ventilation. Inclusion criteria were ventilation for at least 48 h, with at least 24 h in APRV. Descriptive statistics were performed. Measurements and main results: 18 patient encounters met inclusion criteria. Subjects were divided into two groups: neuromuscular disease (14 encounters) and truncal obesity (4 encounters). Lung surface area improved significantly in the first 12-24 h of APRV use: neuromuscular group by 7,600 mm Conclusion: APRV is a safe and effective method for improving atelectasis and oxygenation in children with RLD related to neuromuscular conditions and obesity. Further high-quality prospective studies are needed to establish clear guidelines for its use.