Document Detail


Cardiorespiratory effects of pressure-controlled ventilation with and without inverse ratio in the adult respiratory distress syndrome.
MedLine Citation:
PMID:  8365303     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the cardiorespiratory effects of pressure-controlled ventilation (PCV) and pressure-controlled inverse ratio ventilation (PC-IRV), we compared pressure-controlled ventilation with an inspiratory-to-expiratory time ratio (I/E) of 1/2 (PCV) and of 2/1 (PC-IRV) to volume-controlled ventilation (VCV) with an I/E of 1/2 in 10 patients suffering from the adult respiratory distress syndrome. In all modes, the inspiratory oxygen fraction, tidal volume, respiratory rate, and total positive end-expiratory pressure (PEEPt = applied PEEP + intrinsic PEEP) were kept constant. Each ventilatory mode was applied for 1 h in a randomized order. No significant differences in PaO2 were observed among the three modes. The PaCO2 was lower (p < 0.05) in PC-IRV (39 +/- 4 mm Hg) than in PCV (43 +/- 5 mm Hg) and in VCV (45 +/- 5 mm Hg). The peak airway pressure was significantly lower in PC-IRV than in PCV (p < 0.05) and in PCV than in VCV (p < 0.05), but plateau pressure was not different in the 3 modes. The mean airway pressure (mPaw) was significantly higher (p < 0.05) in PC-IRV (21.4 +/- 0.7 cm H2O) than in PCV (17.1 +/- 0.7 cm H2O) and VCV (16.4 +/- 0.5 cm H2O). As a consequence of this increased mPaw, PC-IRV induced a decrease in cardiac index (CI) (3.3 +/- 0.2 vs 3.7 +/- 0.2 L/min/m2 in VCV; p < 0.05) and hence in oxygen delivery (DO2) (424 +/- 28 vs 469 +/- 38 ml/min/m2 in VCV; p < 0.05). Our results suggest that neither PCV nor PC-IRV bring any benefit over VCV in terms of arterial oxygenation. Moreover, the increase in mPaw induced by PC-IRV may be deleterious to the CI and DO2.
Authors:
A Mercat; L Graïni; J L Teboul; F Lenique; C Richard
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  104     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-10-06     Completed Date:  1993-10-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  871-5     Citation Subset:  AIM; IM    
Affiliation:
Service de Réanimation Médicale, Université Paris-Sud, Hopital de Bicêtre, Le Kremlin Bicêtre, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Airway Resistance
Carbon Dioxide / blood
Female
Hemodynamics*
Humans
Male
Middle Aged
Oxygen / blood
Positive-Pressure Respiration
Respiration, Artificial / methods*
Respiratory Distress Syndrome, Adult / blood,  physiopathology,  therapy*
Respiratory Mechanics*
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Chest. 1993 Sep;104(3):664-5   [PMID:  8365270 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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