scholarly journals Benefit of Physiologically Variable Over Pressure-Controlled Ventilation in a Model of Chronic Obstructive Pulmonary Disease: A Randomized Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Andre Dos Santos Rocha ◽  
Roberta Südy ◽  
Davide Bizzotto ◽  
Miklos Kassai ◽  
Tania Carvalho ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Respiratory Mechanics ◽  
Chronic Obstructive ◽  
Shunt Fraction ◽  
Intrapulmonary Shunt ◽  
Obstructive Pulmonary Disease ◽  
Controlled Ventilation ◽  
Pressure Controlled Ventilation ◽  
Variable Ventilation ◽  
Pressure Controlled

IntroductionThe advantages of physiologically variable ventilation (PVV) based on a spontaneous breathing pattern have been demonstrated in several respiratory conditions. However, its potential benefits in chronic obstructive pulmonary disease (COPD) have not yet been characterized. We used an experimental model of COPD to compare respiratory function outcomes after 6 h of PVV versus conventional pressure-controlled ventilation (PCV).Materials and MethodsRabbits received nebulized elastase and lipopolysaccharide throughout 4 weeks. After 30 days, animals were anesthetized, tracheotomized, and randomized to receive 6 h of physiologically variable (n = 8) or conventional PCV (n = 7). Blood gases, respiratory mechanics, and chest fluoroscopy were assessed hourly.ResultsAfter 6 h of ventilation, animals receiving variable ventilation demonstrated significantly higher oxygenation index (PaO2/FiO2 441 ± 37 (mean ± standard deviation) versus 354 ± 61 mmHg, p < 0.001) and lower respiratory elastance (359 ± 36 versus 463 ± 81 cmH2O/L, p < 0.01) than animals receiving PCV. Animals ventilated with the variable mode also presented less lung derecruitment (decrease in lung aerated area, –3.4 ± 9.9 versus –17.9 ± 6.7%, p < 0.01) and intrapulmonary shunt fraction (9.6 ± 4.1 versus 17.0 ± 5.8%, p < 0.01).ConclusionPVV applied to a model of COPD improved oxygenation, respiratory mechanics, lung aeration, and intrapulmonary shunt fraction compared to conventional ventilation. A reduction in alveolar derecruitment and lung tissue stress leading to better aeration and gas exchange may explain the benefits of PVV.

Pressure-Controlled Mechanical Ventilation Is More Advantageous in the Follow-up of Patients with Chronic Obstructive Pulmonary Disease after Open Heart Surgery

2014 ◽  
Vol 17 (1) ◽  
pp. 1
Author(s):  
Murat Ugurlucan ◽  
Murat Basaran ◽  
Filiz Erdim ◽  
Ozer Selimoglu ◽  
Ilker Murat Caglar ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Chronic Obstructive ◽  
Open Heart ◽  
Obstructive Pulmonary Disease ◽  
Controlled Ventilation ◽  
Hospital Stays ◽  
Pressure Controlled

<p><b>Objective:</b> Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population.</p><p><b>Patients and Methods:</b> Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups.</p><p><b>Results:</b> Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ.</p><p><b>Conclusion:</b> There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.</p>

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