Long-term volume-targeted pressure-controlled ventilation: sense or nonsense?

Abstract

The technology underlying the development of novel ventilatory modes for long-term noninvasive ventilation of patients with chronic hypercapnia is continuously evolving. Volume-targeted pressure-controlled ventilation is a hybrid ventilation mode designed to combine the advantages of conventional ventilation modes, while avoiding their drawbacks. However, manufacturers have created different names and have patented algorithms and set-up variables, which can result in confusion for physicians and respiratory therapists. In addition, clear evidence for the superiority of this novel mode has not yet been established. These factors have most likely hindered more widespread use of this mode in clinical practice. The current review presents the rationale, working principles, characteristics and set-up recommendations associated with volume-targeted modes. In addition, it summarises the clinical and laboratory studies that have challenged this mode.

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

“…Recent developments seek to combine the advantages of volume-and pressure-targeted NIV, while avoiding their disadvantages [76]. In addition, there is a physiological rationale supporting the interest in continuously adapting ventilator parameters to fluctuating patient needs during the night and also over the long term.…”

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].…”

Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas

“…The intrinsic feature of these modes should allow the ventilator to maintain adequate ventilation when respiratory impedance increases thus avoiding unnecessarily high preset inspiratory pressures [53]. VTPCV was initially used for invasive mechanical ventilation [54, 55] and later introduced in the noninvasive mode [55-59].…”

“…However, some clinical evidence suggests that patients might benefit from the VTPCV mode in selected cases [53]. …”

“…Tidal volume (VT) or alveolar volume-targeted pressure-controlled ventilation (VTPCV) are hybrid ventilation modes aimed to combine the advantages of conventional modes, while preventing their possible drawbacks [53]. The intrinsic feature of these modes should allow the ventilator to maintain adequate ventilation when respiratory impedance increases thus avoiding unnecessarily high preset inspiratory pressures [53].…”