Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure A Physiology-Based Narrative and Systematic Review
Por:
Rittayamai, N, Katsios, CM, Beloncle, F, Friedrich, JO, Mancebo, J, Brochard, L
Publicada:
1 ago 2015
Resumen:
BACKGROUND: Mechanical ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes.
METHODS: We performed a systematic review and meta-analysis to determine whether pressure control-continuous mandatory ventilation (PC-CMV) or pressure control-inverse ratio ventilation (PC-IRV) has demonstrated advantages over volume control-continuous mandatory ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models.
RESULTS: Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes.
CONCLUSIONS: The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of ventilation of patients with acute respiratory failure.
Filiaciones:
Rittayamai, N:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Crit Care Dept, Toronto, ON M5B 1W8, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Siriraj Hosp, Div Resp Dis & TB, Dept Med, Fac Med, Bangkok, Thailand
Katsios, CM:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Beloncle, F:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Crit Care Dept, Toronto, ON M5B 1W8, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Angers, Med Intens Care Unit, Hosp Angers, Angers, France
Friedrich, JO:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Crit Care Dept, Toronto, ON M5B 1W8, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Mancebo, J:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Brochard, L:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada
St Michaels Hosp, Crit Care Dept, Toronto, ON M5B 1W8, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
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