Pressure regulated volume controlled ventilation versus synchronized intermittent mandatory ventilation in COPD patients suffering from acute respiratory failure

Abstract

Volume controlled ventilation (VC) allows a set tidal volume to be guaranteed but it causes excessive airway pressures that may lead to barotrauma. Pressure controlled ventilation (PC) limits ventilator-induced lung injury but has a disadvantage of variable tidal volume delivery. Pressure-regulated volume controlled ventilation is a kind of dual-control ventilation that combines the advantages of both volume controlled and pressure controlled ventilation. To compare the pressure regulated volume controlled ventilation (PRVC) versus traditional synchronized intermittent mandatory ventilation (SIMV) in chronic obstructive pulmonary disease (COPD) patients suffering from acute respiratory failure. This prospective study was carried on 30 COPD patients suffering from acute respiratory failure, divided in two groups: group 1 patients were ventilated using the SIMV mode and group 2 patients were ventilated using the PRVC mode. The arterial blood gas (ABG) parameters, ventilation data, complications and prognosis were compared in the two groups. The ABG parameters improved better in the PRVC group after 6 and 48 h. The peak inspiratory pressure (PIP) values were lower in the PRVC group. There were fewer complications (33% in group 2 versus 86% in group 1). The prognosis was better in PRVC group as 13 patients (86%) were weaned, 1 patient (7%) died and 1 patient (7%) failed to be weaned. On the other hand, 6 patients (40%) were weaned, 3 patients (20%) died and 6 patients (40%) failed to be weaned in the SIMV group. The PRVC mode is better than the volume controlled SIMV mode in ventilating COPD patients with acute exacerbations and type II respiratory failure.