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 120 publications

(82 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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“…Despite these potential physiological considerations, there are no outcome advantages of using a pressure-controlled mode over a volume-controlled mode, or vice versa. Indeed, one systematic review and meta-analysis of 34 studies did not suggest differences in any clinical outcome [12]. However, the studies were small and varied considerably in quality, and were at high risk of bias.…”

Section: Modes Of Invasive Mechanical Ventilatory Supportmentioning

confidence: 99%

ARDS: challenges in patient care and frontiers in research

2018

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This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients.Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes. A plateau pressure <30 cmH 2 O is recommended in all patients. It is suggested that a plateau pressure <15 cmH 2 O should be considered safe. Patient with moderate and severe ARDS should receive higher levels of positive endexpiratory pressure (PEEP). Rescue therapies include prone position and neuromuscular blocking agents. Extracorporeal support for decapneisation and oxygenation should only be considered when lungprotective ventilation is no longer possible, or in cases of refractory hypoxaemia, respectively. Tracheotomy is only recommended when prolonged mechanical ventilation is expected.Of all tested pharmacological interventions for ARDS, only treatment with steroids is considered to have benefit.Proper identification of phenotypes, known to respond differently to specific interventions, is increasingly considered important for clinical trials of interventions for ARDS. Such phenotypes could be defined based on clinical parameters, such as the arterial oxygen tension/inspiratory oxygen fraction ratio, but biological marker profiles could be more promising.

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

Cited by 120 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

ARDS: challenges in patient care and frontiers in research

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

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