Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome

Background: Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be a ssociated with improved outcome. To fulfil this approach, sedation, neuromu scular blocking agents and full mechanical ventilatory support are often us ed in critical failure of gas exchange. Case report: We present a patient who developed multiple organ failure, inc luding severe ARDS, after severe skin injuries and septic shock. Ventilator y strategy consisted of lung protective approach, permissive hypercapnia an d prone positioning. Airway pressure release ventilation (APRV) with the pa tient's superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after appli cation of combined use of APRV and prone positioning. Conclusion: APRV and maintenance of patients' spontaneous ventilation is fe asible during prone positioning, and this approach may have beneficial syne rgistic effects on gas exhange in patients with severe acute lung injury.