A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

Abstract

BackgroundCOPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects.ObjectiveWe evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure.Patients and methodsThirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours.ResultsBoth groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05).ConclusionAmong elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation – volume control.

Comparison of Bilevel Volume Guarantee and Pressure-Regulated Volume Control Modes in Preterm Infants

“…A study including 39 older intubated patients with chronic obstructive pulmonary disease compared PRVC and SIMV-VC modes and evaluated the efficacy of PRVC mode and its prevention of pulmonary barotrauma. Assessment of respiratory mechanics, arterial blood gas analysis, and vital signs at 2-4 h and at 48 h showed that PRVC resulted in rapid improvement in arterial blood gas parameters while maintaining low peak inspiratory pressure [25].…”

Influence of ventilatory strategies on outcomes and length of hospital stay: assist-control and synchronized intermittent mandatory ventilation modes

“…Regarding advanced MV modes, SIMV performance remains inferior in the literature, in studies comparing pressure-regulated volume control ventilation, which presents better respiratory conditions and hemodynamic stability [ 1 ]. Thus, advanced MV modes are more often favored than SIMV [ 1 , 26 ]. Other studies compared SIMV with adaptive support ventilation (ASV) as a weaning method, where ASV had shorter duration of MV compared with SIMV [ 27 , 28 ], improved medical outcomes, recovery of airway function, decreased respiratory muscle work and more stable chest pressure [ 29 ].…”

Advanced Modes of Mechanical Ventilation: Introduction for the Critical Care Pharmacist

“…PRVC has demonstrated improved oxygenation, improving arterial blood gas results and lowering peak inspiratory pressures (PIPs) in patients with COPD, acute respiratory distress syndrome (ARDS), and post post-cardiac surgical patients. [15][16][17][18][19] However, the small sample size of the above studies with the absence of larger randomized controlled trials has not demonstrated any greater advantage of PRVC compared to other modes. The ventilator settings for PRVC include a target V T , RR, upper pressure limit, inspiratory time, PEEP, and FIO 2 .…”