Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure

Rittayamai, Nuttapol; Katsios, Christina M.; Beloncle, François; Friedrich, Jan O.; Mancebo, Jordi; Brochard, Laurent

doi:10.1378/chest.14-3169

Cited by 108 publications

(65 citation statements)

References 55 publications

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“…A recent study reported that there was no significant difference in outcomes of the patients ventilated with either VCV or PCV mode (12), but our study showed that VCV mode used in the survival group patients was more than used in nonsurvival group patients. Further studies will be needed to clarify which mode is better exactly.…”

Section: Discussioncontrasting

confidence: 84%

A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes

Zhu

Jiang

et al. 2017

Critical Care Medicine

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Section: Discussioncontrasting

confidence: 84%

A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes

Zhu

Jiang

et al. 2017

Critical Care Medicine

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“…Peak airway pressures may not change sufficiently to trigger alarms during BSD if inspiratory muscle effort is sustained throughout the second machine inspiratory cycle. The incorrect, widely held view that the clinician sets V T in the volume assist-control mode [12–14] further impedes recognition of BSD. The clinician sets only the machine inspiratory cycle volume in volume assist-control.…”

Section: Introductionmentioning

confidence: 99%

Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria

et al. 2016

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Purpose Breath stacking dyssynchrony generates higher tidal volumes than intended, potentially increasing lung injury risk in acute respiratory distress syndrome (ARDS). Lack of validated criteria to quantify breath stacking dyssynchrony contributes to its under-recognition. This study evaluates performance of novel, objective criteria for quantifying breath stacking dyssynchrony (BREATHE Criteria) compared to existing definitions and tests if neuromuscular blockade eliminates high-volume breath stacking dyssynchrony in ARDS. Methods Airway flow and pressure were recorded continuously for up to 72 hours in 33 patients with ARDS receiving volume-preset assist-control ventilation. The flow-time waveform was integrated to calculate tidal volume breath-by-breath. The BREATHE Criteria considered five domains in evaluating for breath stacking dyssynchrony: ventilator cycling, interval expiratory volume, cumulative inspiratory volume, expiratory time, and inspiratory time. Results The observed tidal volume of BREATHE stacked breaths was 11.3 [9.7—13.3] mL/kg predicted body weight, significantly higher than the preset volume (6.3 [6.0—6.8] mL/kg; p<.001). BREATHE identified more high-volume breaths (≥2 mL/kg above intended volume) than the other existing objective criteria for breath stacking (27 [7—59] vs 19 [5—46] breaths/hour; p<.001). Agreement between BREATHE and visual waveform inspection was high (raw agreement 96.4–98.1%; phi 0.80–0.92). Breath stacking dyssynchrony was near-completely eliminated during neuromuscular blockade (0 [0—1] breaths/hour; p<.001). Conclusions The BREATHE Criteria provide an objective definition of breath stacking dyssynchrony emphasizing occult exposure to high tidal volumes. BREATHE identified high-volume breaths missed by other methods for quantifying this dyssynchrony. Neuromuscular blockade prevented breath stacking dyssynchrony, assuring provision of the intended lung-protective strategy.

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“…An overall statistically significant but not clinically significant reduction in V T was also observed after the measurements. Though there is no evidence showing that one mode is superior [13], VCV mode offers several advantageous features compared with PCV mode:Strictly controlling the V T at a target value was proven beneficial for survival [14]. …”

Section: Discussionmentioning

confidence: 99%

Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome

Chen

Shore

et al. 2017

Crit Care

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BackgroundDespite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test.MethodsThe respiratory mechanics assessment constituted a set of bedside measurements to determine passive lung and chest wall mechanics, response to positive end-expiratory pressure, and alveolar derecruitment. It was obtained early after ARDS diagnosis. The results were provided to the clinical team to be used at their own discretion. We compared ventilator settings and physiological variables before and after the test. The physiological endpoints were oxygenation index, dead space, and plateau and driving pressures.ResultsSixty-one consecutive patients with ARDS were enrolled. Esophageal pressure was measured in 53 patients (86.9%). In 41 patients (67.2%), ventilator settings were changed after the measurements, often by reducing positive end-expiratory pressure or by switching pressure-targeted mode to volume-targeted mode. Following changes, the oxygenation index, airway plateau, and driving pressures were significantly improved, whereas the dead-space fraction remained unchanged. The oxygenation index continued to improve in the next 48 h.ConclusionsImplementing a systematic respiratory mechanics test leads to frequent individual adaptations of ventilator settings and allows improvement in oxygenation indexes and reduction of the risk of overdistention at the same time.Trial registrationThe present study involves data from our ongoing registry for respiratory mechanics (ClinicalTrials.gov identifier: NCT02623192. Registered 30 July 2015).Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1671-8) contains supplementary material, which is available to authorized users.

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Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure

Cited by 108 publications

References 55 publications

A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes

A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes

Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria

Implementing a bedside assessment of respiratory mechanics in patients with acute respiratory distress syndrome

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