A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure

Guldager, H; Nielsen, Soeren L; Carl, P; Soerensen, Mogens B

doi:10.1186/cc107

Cited by 45 publications

(10 citation statements)

References 12 publications

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“…We noted a large percentage of patients in our study cohort were managed with APC ventilation, which is a dual-controlled ventilation wherein the ventilator attempts to achieve tidal volume using a pressure-limited delivery format at the lowest possible airway pressure. While this mode of ventilation may decrease peak inspiratory pressures, no evidence exists that APC improves outcomes [27]. It is possible some of the differences we observed may be confounded by varying management strategies at different ICUs, some of which use APC more than others.…”

Section: Discussionmentioning

confidence: 98%

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

et al. 2019

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Background: In patients with acute respiratory distress syndrome (ARDS), low tidal volume ventilation has been associated with reduced mortality. Driving pressure (tidal volume normalized to respiratory system compliance) may be an even stronger predictor of ARDS survival than tidal volume. We sought to study whether these associations hold true in acute respiratory failure patients without ARDS. Methods: This is a retrospectively cohort analysis of mechanically ventilated adult patients admitted to ICUs from 12 hospitals over 2 years. We used natural language processing of chest radiograph reports and data from the electronic medical record to identify patients who had ARDS. We used multivariable logistic regression and generalized linear models to estimate associations between tidal volume, driving pressure, and respiratory system compliance with adjusted 30-day mortality using covariates of Acute Physiology Score (APS), Charlson Comorbidity Index (CCI), age, and PaO 2 /FiO 2 ratio. Results: We studied 2641 patients; 48% had ARDS (n = 1273). Patients with ARDS had higher mean APS (25 vs. 23, p < .001) but similar CCI (4 vs. 3, p = 0.6) scores. For non-ARDS patients, tidal volume was associated with increased adjusted mortality (OR 1.18 per 1 mL/kg PBW increase in tidal volume, CI 1.04 to 1.35, p = 0.010). We observed no association between driving pressure or respiratory compliance and mortality in patients without ARDS. In ARDS patients, both ΔP (OR1.1, CI 1.06-1.14, p < 0.001) and tidal volume (OR 1.17, CI 1.04-1.31, p = 0.007) were associated with mortality. Conclusions: In a large retrospective analysis of critically ill non-ARDS patients receiving mechanical ventilation, we found that tidal volume was associated with 30-day mortality, while driving pressure was not.

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Section: Discussionmentioning

confidence: 98%

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

et al. 2019

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“…This gives our study all its originality but on the other hand makes the discussion of the results difficult. Compared to VC mode, VC mode with regulated pressure is associated with lower inspiratory pressures 141718. In a randomized controlled trial evaluating AFVC mode in controlled ventilatory ventilation, this mode allowed fewer alarms by reducing inspiratory pressures 5.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery: It is no necessary to change ventilator mode to improve ventilation conditions; a controlled trial

Mounir¹,

Tarik²,

Hamzaoui³

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims The main objective of this study is to compare the ventilatory effects of AFVC and PC modes with the VC mode in laparoscopic surgery of the gall bladder. Methods Thirty-five patients programmed for laparoscopic cholecystectomy were included. Four times were defined for all patients. The parameters studied were recorded ten minutes after anesthetic induction; and this is the time T1. The time T2 fits to 10 min after induction of pneumoperitoneum. Then, the ventilator mode was changed from VC mode to AFVC mode. Ten minutes later, the variables were scored; it was the time T3. The ventilator mode was then changed to a PC mode. The set pressure was adjusted in order to obtain the same Vt as at the time T2. The time T4 was 10 minutes after switching to PC mode. Results The Vte were increased, compared to time T2, during the AFVC and PC modes. The induction of pneumoperitoneum with CO 2 induced a rise of P ET CO 2 between T1 and T2. These had been accompanied by a significant rise in airway pressures. The change from VC mode to AFVC mode resulted in lower Prpeak and Prtray elevation without impacting dynamic compliance. Conclusions AFVC mode appears safe for patients in laparoscopic surgery. Its use, compared with VC, is associated with a decrease in Prpeak without effects on the Cdyn, oxygenation, capnia and hemodynamic parameters. We conclude that is no necessary to change ventlatory modes to improve ventilation conditions in non-obese patients.

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“…The NDL was ventilated in PRVC mode,[ 4 ] a pressure controlled mode designed to provide the set target tidal volume at the lowest peak pressure. In none of the patients, the peak pressure during NDL exceeded 10 cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of ventilation of nondependent lung for a brief period in improving arterial oxygenation during one-lung ventilation: A prospective study

et al. 2017

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Background:Hypoxemia is common during one-lung ventilation(OLV), predominantly due to transpulmonary shunt. None of the strategies tried showed consistent results. We evaluated the effectiveness of ventilating the operated, non-dependent lung (NDL) with small tidal volumes in improving the oxygenation during OLV.Methods:30 ASA 1 and 2 patients undergoing elective, open thoracotomy were studied. After standard induction of anesthesia, lung seperation was acheived with left sided DLT. The ventilatory settings for two lung ventilation (TLV) were: FiO2 of 0.5, tidal volume of 8-10ml/kg and respiratory rate of 10-12/min. After initiating OLV, the dependent lung alone was ventilated with the above settings for 15 minutes and an arterial blood gas (ABG) analysis was done. Then the NDL was ventilated with a separate ventilator, with FiO2 of 1, tidal volume of 70 ml, I:E ratio of 1:10 and respiratory rate of 6/min for 15 minutes. The NDL ventilation was started early if the patients desaturated to <95%. ABG was done at 5 and 15 mins of NDL ventilation. We compared the PaO2 values.Results:The mean PaO2 decreased from 232.2 ± 67.2 mm of Hg (TLV-ABG1) to 91.2 ± 31.7 mm of Hg on OLV (OLV-ABG1). The ABG after 5 minutes and 15 minutes after institution of NDL ventilation during OLV showed a PaO2 of 145.7 ± 50.2 mm of Hg and 170.6 ± 50.4 mm of Hg which were significantly higher compared to the one lung ventilation values.

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A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure

Cited by 45 publications

References 12 publications

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

Laparoscopic surgery: It is no necessary to change ventilator mode to improve ventilation conditions; a controlled trial

Effectiveness of ventilation of nondependent lung for a brief period in improving arterial oxygenation during one-lung ventilation: A prospective study

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