Pressure-controlled, inverse ratio ventilation that avoids air trapping in the adult respiratory distress syndrome

Abstract

These data demonstrate that oxygenation is primarily a function of mean airway pressure, and that longer inspiratory times can be used as an alternative to applied PEEP to increase this oxygenation. If no air trapping develops, lung inflation pressures and delivered volumes remain constant with this approach. Because the technique was used only in patients refractory to conventional techniques, the poor outcome is not surprising.

The effects of inverse ratio ventilation on intracranial pressure: a preliminary report

“…In the second observation, where CO 2 was corrected for, the change in ICP was reduced as was the tidal volume required. This indicates that PC-IRV was a more efficient form of ventilation and is consistent with other research [9].…”

“…This suggests that changes in CO 2 are more important than changes in Paw in influencing ICP. Cardiac index and has been shown to increase [4] or decrease [8,9] with PC-IRV in previous studies. The effect on cardiac index was not measured in this study.…”

“…The effect of PC-IRV includes raising the mean airway pressure (Paw) whilst reducing PIP and the generation of intrinsic PEEP [4][5][6]. Reports vary as to the impact on PaCO 2 [4,7] and cardiac function [4,8,9].…”

High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation

“…It has been observed that application of either pcCMV or vcCMV is associated with the occurrence of barotrauma in 0.5-20 % of the cases [8,[51][52][53][54][55][56][57][58][59]. A closer look at several studies using pcCMV-IRV in ARDS patients suggests that the frequent occurrence of barotrauma can be attributed to the use of high airway pressures exceeding 35 cmH 2 O, which promote barotrauma [8,53,60].…”

“…A closer look at several studies using pcCMV-IRV in ARDS patients suggests that the frequent occurrence of barotrauma can be attributed to the use of high airway pressures exceeding 35 cmH 2 O, which promote barotrauma [8,53,60]. The application of a PIP of 33 ± 8 cmH 2 O in the pcCMV mode instead of 48 ± 14 cmH 2 O in the vcCMV mode reduced the incidence of pneumothorax in severe ARF significantly [49].…”