Airway pressure-release ventilation in pregnant patients with acute respiratory distress syndrome: A novel strategy

BACKGROUND: Airway pressure-release ventilation (APRV) is a novel mode of positive-pressure ventilation that has several advantages over low-tidal-volume, assist-control ventilation in patients with acute respiratory distress syndrome, specifically, lower airway pressures, lower minute ventilation, minimal effects on cardio-circulatory function, ability to spontaneously breathe throughout the entire ventilatory cycle, and decreased sedation requirements. APRV is consistent with lungprotective strategies that aim to limit lung injury associated with mechanical ventilation. APRV utilization in obstetrical patients has not previously been reported. CASES: We present 2 cases of pregnant women with severe life-threatening ARDS who were successfully managed with APRV. CONCLUSIONS: APRV may have particular utility in pregnant patients with ARDS. We believe APRV was life-saving in our cases. APRV ventilation should be considered in pregnant patients with ARDS.