Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow

1993 ◽  
Vol 21 (8) ◽  
pp. 1143-1148 ◽  
Author(s):  
JAVIER MUÑOZ ◽  
JOSE EUGENIO GUERRERO ◽  
JOSE LUIS ESCALANTE ◽  
RICARDO PALOMINO ◽  
BRAULIO DE LA CALLE
Keyword(s):  
Mechanical Ventilation ◽  
Inspiratory Flow ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Controlled Mechanical Ventilation ◽  
Pressure Controlled

scholarly journals Comparison Between Volume Controlled Ventilation And Pressure Controlled Ventilation In Morbidly Obese Patients Undergoing Laparoscopic Gastric sleeve Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Elshafie ◽  
D M A Elfawy ◽  
A A Abdelhak ◽  
Y N Abdelalim
Keyword(s):  
Mechanical Ventilation ◽  
Obese Patients ◽  
Gastric Sleeve ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Ventilation Setting ◽  
Gastric Sleeve Surgery ◽  
Volume Controlled ◽  
Pressure Controlled

Abstract Background Although numerous studies conducted in the past years, there is no superior guideline that indicates the best ventilation mode during laparoscopic anesthesia inobese patients. There are numerous studies with dissimilar controversial points. The management of oxygenation in a morbid obese patient undergoing laparoscopic procedures presents many challenging aspects to the anesthetist. Objective The aim of this study was to equate the effect of pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on respiratory, oxygenation parameters and post operative complications. Patients and Methods This study was conducted on 80 patients who underwent laparoscopic gastric sleeve surgery in Ain Shams University Hospitals. Post induction of Anesthesia, Patients were divided into two groups. The first group mechanical ventilation setting was volume controlled ventilation and the second group mechanical ventilation setting was pressure controlled ventilation. Results The results of our study shows that despite some valuable effects regarding plateau and mean airway pressure with PCV, there is no momentous clinical difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) in obese patients undergoing laparoscopic gastric sleeve surgery. However, pressure controlled ventilation shows slightly more favorable results regarding post extubation oxygen saturation and the decrease of post operative basal atelectasis. It appears that using dual modes would be an epitome approach with lower complications and similar outcomes.

scholarly journals Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andre Dos Santos Rocha ◽  
Gergely H. Fodor ◽  
Miklos Kassai ◽  
Loic Degrugilliers ◽  
Sam Bayat ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Lung Inflammation ◽  
Distress Syndrome ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Regional Lung ◽  
Variable Ventilation ◽  
Pressure Controlled

Abstract Background Benefits of variable mechanical ventilation based on the physiological breathing pattern have been observed both in healthy and injured lungs. These benefits have not been characterized in pediatric models and the effect of this ventilation mode on regional distribution of lung inflammation also remains controversial. Here, we compare structural, molecular and functional outcomes reflecting regional inflammation between PVV and conventional pressure-controlled ventilation (PCV) in a pediatric model of healthy lungs and acute respiratory distress syndrome (ARDS). Methods New-Zealand White rabbit pups (n = 36, 670 ± 20 g [half-width 95% confidence interval]), with healthy lungs or after induction of ARDS, were randomized to five hours of mechanical ventilation with PCV or PVV. Regional lung aeration, inflammation and perfusion were assessed using x-ray computed tomography, positron-emission tomography and single-photon emission computed tomography, respectively. Ventilation parameters, blood gases and respiratory tissue elastance were recorded hourly. Results Mechanical ventilation worsened respiratory elastance in healthy and ARDS animals ventilated with PCV (11 ± 8%, 6 ± 3%, p < 0.04), however, this trend was improved by PVV (1 ± 4%, − 6 ± 2%). Animals receiving PVV presented reduced inflammation as assessed by lung normalized [18F]fluorodeoxyglucose uptake in healthy (1.49 ± 0.62 standardized uptake value, SUV) and ARDS animals (1.86 ± 0.47 SUV) compared to PCV (2.33 ± 0.775 and 2.28 ± 0.3 SUV, respectively, p < 0.05), particularly in the well and poorly aerated lung zones. No benefit of PVV could be detected on regional blood perfusion or blood gas parameters. Conclusions Variable ventilation based on a physiological respiratory pattern, compared to conventional pressure-controlled ventilation, reduced global and regional inflammation in both healthy and injured lungs of juvenile rabbits.

scholarly journals Pressure-controlled ventilation-volume guaranteed (PCV-VG) for postoperative pulmonary complications: a protocol for a systematic review with meta-analysis and trial sequential analysis

2021 ◽  
Author(s):  
Jianqiao Zheng ◽  
Li Du ◽  
Xiaoqian Deng ◽  
Lu Zhang ◽  
Jia Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Sequential Analysis ◽  
Pulmonary Complications ◽  
Trial Sequential Analysis ◽  
Postoperative Pulmonary Complications ◽  
Ventilation Mode ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

Abstract BackgroundMore than 300 million major surgical procedures are performed worldwide yearly. Above 30% of patients undergoing surgery with mechanical ventilation may experience postoperative pulmonary complications (PPCs). PPCs are the main cause of perioperative morbidity and mortality and it can be decreased by optimizing the mechanical ventilation. Pressure-controlled ventilation-volume guaranteed (PCV-VG) is a new ventilation mode, which combines the advantages of volume-controlled ventilation and pressure-controlled ventilation, might reduce PPCs. The efficacy of PCV-VG for PPCs has not yet been systematically reviewed. Hence, we will conduct a systematic review to evaluate the efficacy of PCV-VG for PPCs. The aim of this protocol is to investigate the benefits of PCV-VG versus conventional ventilation mode for PPCs.MethodsWe will search PubMed, Web of Science, Cochrane Library, Ovid medline, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang and VIP databases from their inception until May 2021, to identify randomised controlled studies using related keywords. Simultaneously, clinical registration tests and gray literature will also be retrieved. Studies published in English or Chinese will be considered. The primary outcome will be the incidence of PPCs, secondary outcomes will be intraoperative parameters of respiratory and hemodynamic function. Data synthesis/statistical analyses will be performed using the Review Manager software (version 5.4) and Stata (version 16). Heterogeneity will be assessed by the standard chi-square test and I2 statistic. Two authors will independently search, extract data from and assess the risk bias of included studies according the Cochrane risk of bias tool. Trial sequential analysis will be used to control the risks of random errors. Funnel plots and Egger’s regression test will be used to assess the publication bias. Certainty of the evidence will be assessed by modified Jadad Scale.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on the efficacy of PCV-VG for PPCs. Our results will help clinical decision-making and support the development of clinical practice guidelines.

Usefulness of pressure-controlled ventilation at high inspiratory pressures to induce acute lung injury in mice

2008 ◽  
Vol 295 (4) ◽  
pp. L718-L724 ◽  
Author(s):  
Tobias Eckle ◽  
Lars Füllbier ◽  
Almut Grenz ◽  
Holger K. Eltzschig
Keyword(s):  
Mechanical Ventilation ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Prolonged Mechanical Ventilation ◽  
Mouse Strains ◽  
Myeloperoxidase Activity ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Inflammatory Protein ◽  
Pressure Controlled

Acute lung injury (ALI), as occurs with prolonged mechanical ventilation, contributes to morbidity and mortality of critical illness, and studies on novel genetic or pharmacological targets are areas of intense investigation. Here, we systematically tested a murine model of ALI by using pressure-controlled ventilation to induce ventilator-induced lung injury. For this purpose, C57BL/6 or Sv129 mice were anesthetized and underwent tracheotomy followed by induction of ALI via mechanical ventilation. Mice were ventilated in a pressure-controlled setting at different inspiratory pressure levels (15–45 mbar) and over different times (0–90 min, 100% oxygen). As outcome parameters, we assessed pulmonary edema (wet-to-dry ratios), bronchoalveolar fluid albumin content, pulmonary myeloperoxidase activity, macrophage inflammatory protein-2, and pulmonary gas exchange. These studies revealed maximal differences in severity of lung injury between different mouse strains after 90 min of ventilation time at 45 mbar. Use of lower concentrations of inspired oxygen did not alter disease severity. Increases of CD73 transcript (5′-ectonucleotidase, pacemaker of extracellular adenosine production) or total pulmonary adenosine levels with mechanical ventilation were less pronounced in C57BL/6 mice, suggesting attenuated adenosine protection in C57BL/6 mice. Together, these studies demonstrate feasibility of this model to induce murine ALI.

scholarly journals Incidence of tracheal aspiration in tracheotomized patients in use of mechanical ventilation

2009 ◽  
Vol 46 (4) ◽  
pp. 311-314 ◽  
Author(s):  
Mariana de Almeida Simão ◽  
Camila Albuquerque Nobre Alacid ◽  
Katia Alonso Rodrigues ◽  
Christiane Albuquerque ◽  
Ana Maria Furkim
Keyword(s):  
Mechanical Ventilation ◽  
Statistical Significance ◽  
Oropharyngeal Dysphagia ◽  
Blue Dye ◽  
Ventilation Mode ◽  
Sedation Level ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled ◽  
Tracheal Aspiration

CONTEXT: Many patients in use of mechanical ventilation show clinical complications due to tracheal aspiration. Assessment and early methods are necessary, so that preventive and safety measures apply to this patients OBJECTIVE: To study the incidence of tracheal aspiration of saliva in tracheotomized patients treated in intensive care unit using two modes of mechanical ventilation and with different sedation levels. METHOD: Prospective study with 14 tracheotomized non-neurological patients using mechanical ventilation. The sample was divided into two groups based on ventilation mode: pressure support ventilation and pressure controlled ventilation. Those two groups were subdivided into two others according to sedation level. The speech pathology evaluation was completed via the blue dye test in order to analyze the incidence of tracheal aspiration of saliva. RESULTS: Sedation levels and mechanical ventilation time related to tracheal aspiration were not statistically significant in this study. On the other hand, ventilation mode and tracheal aspiration showed statistical significance, and there was a higher incidence of tracheal aspiration in the pressure controlled ventilation mode. CONCLUSION: It was possible to observe a significant relationship between tracheal aspiration incidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research.

scholarly journals Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (6) ◽  
pp. 1276
Author(s):  
Volker Schick ◽  
Fabian Dusse ◽  
Ronny Eckardt ◽  
Steffen Kerkhoff ◽  
Simone Commotio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Volume Controlled Ventilation ◽  
Volume Controlled ◽  
Pressure Controlled

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

Lung regional stress and strain as a function of posture and ventilatory mode

2011 ◽  
Vol 110 (5) ◽  
pp. 1374-1383 ◽  
Author(s):  
Gaetano Perchiazzi ◽  
Christian Rylander ◽  
Antonio Vena ◽  
Savino Derosa ◽  
Debora Polieri ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Volume Control ◽  
Dynamic Strain ◽  
Positive Pressure ◽  
Stress And Strain ◽  
Prone Positioning ◽  
Ventilatory Mode ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

During positive-pressure ventilation parenchymal deformation can be assessed as strain (volume increase above functional residual capacity) in response to stress (transpulmonary pressure). The aim of this study was to explore the relationship between stress and strain on the regional level using computed tomography in anesthetized healthy pigs in two postures and two patterns of breathing. Airway opening and esophageal pressures were used to calculate stress; change of gas content as assessed from computed tomography was used to calculate strain. Static stress-strain curves and dynamic strain-time curves were constructed, the latter during the inspiratory phase of volume and pressure-controlled ventilation, both in supine and prone position. The lung was divided into nondependent, intermediate, dependent, and central regions: their curves were modeled by exponential regression and examined for statistically significant differences. In all the examined regions, there were strong but different exponential relations between stress and strain. During mechanical ventilation, the end-inspiratory strain was higher in the dependent than in the nondependent regions. No differences between volume- and pressure-controlled ventilation were found. However, during volume control ventilation, prone positioning decreased the end-inspiratory strain of dependent regions and increased it in nondependent regions, resulting in reduced strain gradient. Strain is inhomogeneously distributed within the healthy lung. Prone positioning attenuates differences between dependent and nondependent regions. The regional effects of ventilatory mode and body positioning should be further explored in patients with acute lung injury.

Sign in / Sign up

Export Citation Format

Share Document