Author: Bein, Thomas; Grasso, Salvatore; Moerer, Onnen; Quintel, Michael; Guerin, Claude; Deja, Maria; Brondani, Anita; Mehta, Sangeeta
Title: The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia Document date: 2016_4_4
ID: krpg9u1u_11
Snippet: Whether pressure-controlled ventilation (PCV) can reduce ventilator-associated lung injury (VALI) compared to volume-controlled (VCV) ventilation is a matter of debate. A meta-analysis [14] of three randomized controlled trials (RCTs) concluded that PCV was not superior to VCV, with a relative risk of hospital and ICU mortality for PCV versus VCV of 0.83 (95 % CI 0.67-1.02; p = 0.08) and 0.84 (95 % CI 0.71-0.99; p = 0.04), respectively. Another s.....
Document: Whether pressure-controlled ventilation (PCV) can reduce ventilator-associated lung injury (VALI) compared to volume-controlled (VCV) ventilation is a matter of debate. A meta-analysis [14] of three randomized controlled trials (RCTs) concluded that PCV was not superior to VCV, with a relative risk of hospital and ICU mortality for PCV versus VCV of 0.83 (95 % CI 0.67-1.02; p = 0.08) and 0.84 (95 % CI 0.71-0.99; p = 0.04), respectively. Another systematic review which included 34 studies concluded that outcome is "unlikely influenced by simply using one breath type vs the other for all patients" [15] . Since flow, driving pressure, and frequency determine the power, and the factor by which ventilation injures the lungs, it seems unlikely that the manner in which this power is delivered (i.e., flow pattern) plays a major role. Airway pressure release ventilation provides a potential recruitment by increased airway pressure and allows spontaneous breathing, with some potential benefits (decreased sedation, shorter mechanical ventilation, and improvement in cardiac performance). Highfrequency oscillatory ventilation delivers very small tidal volumes, to prevent volutrauma, at a constant (relatively high) mean airway pressure. Despite their theoretical benefits, the clinical evidence of both techniques remains unproven and controversial for ARDS patients [16] .
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