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2003, Number 5

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Cir Cir 2003; 71 (5)

Pulmonary mechanics, oxygenation index, and alveolar ventilation in patients with two controlled ventilatory modes. A comparative crossover study

Castañón-González JA, León-Gutiérrez MA, Gallegos-Pérez H, Pech-Quijano J, Martínez-Gutiérrez M, Olvera-Chávez A

Language: Spanish
References: 20
Page: 374-378
PDF size: 57.75 Kb.


ABSTRACT

Objective: To compare in a crossover study pulmonary mechanics, oxigenation index (PaO2/FiO2), and partial pressure of CO2 in arterial blood (PaCO2) in patients with mechanical ventilation in two controlled ventilatory modes. Setting: Intensive care unit of a university affiliated hospital. Design: Prospective crossover clinical trial. Patients and methods: A total 114 consecutive patients were admitted to the intensive care unit (ICU) under controlled mechanical ventilation with SaO2 >90% and FiO2 <0.5 and assigned by random allocation to either volume control (VC) and constant inspiratory flow (square flow curve) (group I) or pressure control mode (PC) (group II). Both groups were ventilated with tidal volume (Vt) of 7 ml/kg, respiratory rate (RR) 14/min, inspiratory-expiratory ratio 1:2 (I:E), PEEP 5 cm H2O, and FiO2 0.4. After 15 min of mechanical ventilation, pulmonary mechanics, oxygenation index (OI), and PaCO2 were measured and registered, and ventilatory mode was switched to PC mode in group I and to VC in group II, maintaining the same ventilator settings. Pulmonary mechanics, OI, and PaCO2 were again registered after 15 min of ventilation. Results: Peak inspiratory pressure (PIP) was higher in VC than in PC (31.5 vs 26 cm H2O), which resulted in a significant increase in transpulmonary pressure amplitude difference (DP) (25 vs 19 cm H2O) . Mean airway pressure (MAP) and OI were lower in VC than in PC (11.5 vs 12 cm H2O, and 198.5 vs 215, respectively). Dynamic compliance (DynC) was lower in VC than in PC (20 vs 26 ml/cm H2O), p < 0.05 for all values. At constant ventilator settings in the same patient, PC and not VC ventilation decreases PIP (which results in smaller transpulmonary pressure amplitude difference), increases MAP, and DynC and improves the oxygenation index.


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