{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T04:42:28Z","timestamp":1760071348649,"version":"build-2065373602"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Rationale<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine the use of airway pressure release ventilation (APRV) in patients with restrictive lung disease as an effective open-lung tool maneuver.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2005h, with at least 24\u2005h in APRV. Descriptive statistics were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and main results<\/jats:title><jats:p>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\u201324\u2005h of APRV use: neuromuscular group by 7,600\u2005mm<jats:sup>2<\/jats:sup> [95% CI, 4,000\u201311,000\u2005mm<jats:sup>2<\/jats:sup>]; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001, and obesity group by 15,000\u2005mm<jats:sup>2<\/jats:sup> [95% CI, 3,000\u201327,000]; <jats:italic>p<\/jats:italic>\u2009=\u20090.018. Atelectasis improved at 12\u201324\u2005h and 48\u2005h from starting APRV, with mean differences of 14% [95% CI, 4%\u201324%]; <jats:italic>p<\/jats:italic>\u2009=\u20090.005 and 14% [95% CI, 3%\u201325%]; <jats:italic>p<\/jats:italic>\u2009=\u20090.009, respectively. As expected, oxygenation improved substantially in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1662233","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T04:15:37Z","timestamp":1760069737000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Airway pressure release ventilation as a recruitment maneuver in mechanically ventilated children with restrictive lung disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Mashael F.","family":"Alqahtani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica E.","family":"Allen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig M.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy 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Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1662233\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T04:15:39Z","timestamp":1760069739000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1662233\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":12,"alternative-id":["10.3389\/fped.2025.1662233"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1662233","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"article-number":"1662233"}}