Clinical management of pressure control ventilation: An algorithmic method of patient ventilatory management to address “forgotten but important variables”

Abstract

Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation. This algorithmic approach highlights the need for clinicians to have a comprehensive conceptual understanding of mechanical ventilation, pulmonary physiology, and interpretation of ventilator graphics in order to best care for patients receiving pressure controlled ventilation. The objective of identifying a systematic approach to managing pressure controlled ventilation is to provide a more generalizable and equitable approach to management of the ICU patient. Ideally, a consistent approach to managing pressure controlled ventilation in the adult population will glean more reliable information regarding actual patient outcomes, as well as the efficacy of pressure controlled ventilation when compared to volume controlled ventilation.

Removal of a catheter mount and heat-and-moisture exchanger improves hypercapnia in patients with acute respiratory distress syndrome

“…In the A/C-pressure control ventilation mode, the inspiratory time tends to be within the range of 0.7 to 1.0 seconds. [ 30 ] However, in the present study, the median inspiratory time was 1.5 (1.3–1.5) seconds. In a recent study of ARDS patients, the end-inspiratory pause prolongation was reported to induce a significant decrease in the levels of PaCO 2 .…”

Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients

“…Thus, some guidelines recommend initial inspiratory pressure settings as low as 5–10 cmH 2 O. 4 To help filter noise and fluctuating data, 10% of these values are used as the threshold to define what constitutes a ‘true’ breath. Hence, 10% of 400 mL (40 mL), 60 L/min (6 L/min) and 10 cmH 2 O (1 cmH 2 O) are listed as these criteria, which set very low thresholds and thus exclude relatively few breaths while ensuring those breaths captured are not influenced by partial breaths or coughs and asynchrony.…”

Застосування Режиму Штучної Вентиляції Легень У Новонароджених З Гіпоксично-Ішемічною Енцефалопатією

“…Одним із вірогідних пояснень такої різниці поміж застосовуваними режимами може бути мінімізація коливань рівня рСО 2 при застосуванні PRVC з контро-льованим хвилинним об'ємом вентиляції на противагу SIMV/PSV та РС, де дихальний об'єм є похідною величиною та може істотно коливатись при вентиляції в режимах із контрольованим тиском у дихальних шляхах при змінах комплаєнсу легень, що призводитиме до флуктуацій рСО 2 як у бік гіперкапнії, так і гіпокапнії. Своєю чергою, рівень рСО 2 відіграватиме одну з провідних ролей у впливі на стан авторегуляції тонусу мозкових артерій [40][41][42].…”