Hemodynamic Effects of Volume-Controlled Ventilation Versus Pressure-Controlled Ventilation in Head Trauma Patients

Abstract

Background. Controlled ventilation for head trauma patients should reduce hypoxemia, hypercapnia and prevent secondary brain injury. However, changes in cardiac output and arterial blood pressure are the common consequences of mechanical ventilation. This study was designed to compare pressure-versus volume-controlled ventilation modes in severe head trauma patients to identify the mode with least hemodynamic compromise and best oxygenation profi le. Methods. This prospective crossover study was carried out on 15 severe head trauma patients admitted to surgical ICU for mechanical ventilation and critical care. All patients were initially ventilated with volume-controlled ventilation for 12 hours then the mode of ventilation was changed to pressure-controlled ventilation for the next 12 hours. Arterial and pulmonary artery catheters were inserted for continuous monitoring of arterial blood pressure, cardiac output, pulmonary artery pressure, pulmonary wedge pressure, pulmonary vascular resistance, and systemic vascular resistance every 4 hours from the start of each ventilation mode. Lung mechanics and arterial blood gases were simultaneously recorded during the times of hemodynamic monitoring. Results. Cardiac output did not show signifi cant changes between the 2 ventilation modes and mean group differences at 4, 8, and 12 hours were − 0.2, − 0.2, − 0.1 L/min (95% confi dence interval = − 1.04 to 0.64, − 0.92 to 0.52, and − 0.68 to 0.48 L/min), respectively. Additionally, the other hemodynamic variables were comparable at all levels of study analysis. Volume-controlled ventilation was associated with signifi cant higher peak air way pressure in comparison with pressure-controlled ventilation after 4, 8, and 12 hours. The oxygenation values and other lung mechanics were not signifi cantly change between the 2 ventilation modes. Conclusion. Both volume-controlled and pressure-controlled ventilations have comparable hemodynamic and oxygenation profi les in severe head trauma patients for short-term ventilation.

Is volume-controlled ventilation superior to pressure-controlled ventilation in patients with severe brain lesions? A pilot study

“…Mechanical ventilation is the most used short-term life support technique worldwide, and it is used daily for a myriad indications (14). Only a small number of previous studies compared the two major ventilation modes in general intensive care as well as in patients with severe cerebral disorders (12,13,(20)(21)(22). Until now, outcome improvement has not been shown for either ventilation mode (22,23).…”

“…Previous studies have investigated the effect of speci c ventilatory factors on ICP and CPP, for example, the in uence of positive end-expiratory pressure (PEEP) or the ratio of inspiration to expiration (5)(6)(7)(8). However, studies observing different ventilation modes in neurocritical care patients are scarce in the literature (9)(10)(11)(12)(13). There are two major modes of controlled mechanical ventilation: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV).…”

Análise comparativa dos modos ventilatórios Ventilação Controlada a Volume (VCV), Ventilação a Pressão Controlada (PCV) e Ventilação com Pressão Regulada e Volume Controlado (PRVC) sobre mecânica ventilatória, tempo de ventilação mecânica, internação em UTI e sobrevida em pacientes neurológicos

“…No entanto, a escolha da melhor modalidade e parâmetros ventilatórios devem ser estudadas com o objetivo de traçar estratética terapêutica ideal, levando em conta as alterações que ocorrem na mecânica ventilatória impostas pela VM que podem causar alterações hemodinâmicas, vetilatórias e gasométricas (Othman et al, 2013;Kacmarek et al, 2017) interferindo negativamente no sistema nervoso central (SNC), e a prevenção de possíveis lesões no sistema respitório (Sykora et al, 2016).…”