Impact of ventilation strategy during the transition phase of ARDS: Synchronized vs. non-synchronized pressure-regulated vs. volume-controlled mode - A randomized crossover study - 07/11/26
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Abstract |
Background |
There is limited data on the optimal ventilation strategy during the transition phase of Acute Respiratory Distress Syndrome (ARDS) when spontaneous breathing is resumed and lung recovery is ongoing. Volume assist-control ventilation (ACV Vol ) is commonly used, but the constant inspiratory flow and the pressurization synchronized to patient effort may have some disadvantages during this phase. Pressure Regulated Volume Control (PRVC) and Pressure-Controlled ventilation with non-synchronized Spontaneous Ventilation (PC-SV) have been proposed to reduce lung stress and increase respiratory variability. This study aimed to compare the physiological effects of ACV Vol , PRVC, and PC-SV during the transition phase, focusing on gas exchange, ventilator-induced lung injury (VILI) risk, and respiratory variability.
Methods |
In this prospective crossover study, ACV Vol , PRVC, and PC-SV were applied for three 45-minute periods in a randomized order once spontaneous ventilation reached 20–30% of minute ventilation in PC-SV. Ventilator settings ensured similar positive end-expiratory pressure, tidal volume (V T ), and respiratory rate (RR) across modes. Gas exchange, hemodynamics, airway and esophageal pressures, electrical impedance tomography (EIT) volume distribution, dyspnea (MV-RDOS), pressure–time product (PTP) and V T , RR and PTP variability were measured.
Results |
Nineteen patients completed the study. Sedation level, total RR and V T did not differ between ACV Vol , PRVC and PC-SV. Gas exchange, MV-RDOS score, PTP and transpulmonary, alveolar and transalveolar pressure showed no significant differences among the three modes. No differences in ventilation distribution or Pendelluft were observed. V T variability was however significantly higher in PC-SV than in ACV Vol and PRVC, and PTP variability was higher in PC-SV than in ACV Vol . RR variability did not differ among the three modes.
Conclusions |
During the transition phase of ARDS, neither synchronized nor non-synchronized pressure-regulated modes affect gas exchange, dyspnea, or inspiratory effort compared to volume-controlled mode. Similarly, transpulmonary, alveolar, and transalveolar pressures, as well as ventilation distribution, do not differ among the three modes. However, V T and respiratory effort variabilities are higher in the non-synchronized pressure mode.
Trial registration |
ClinicalTrials.gov, identifier: NCT04196738 . Registered on June 30, 2020.
Le texte complet de cet article est disponible en PDF.List of abbreviations : ACV Vol , ARDS, C L , C RS , EELI, EELV, EIT, GI, ICU, MV-RDOS, P0.1, P alv , P aw , PC-SV, PEEP, P es , PL,alv , PL , P Plat , PRVC, P-SILI, PTP, RASS, R aw , ROI, RR, SAPS, SOFA, VILI, V T , WOB
Keywords : ARDS, Weaning, Mechanical ventilation, Spontaneous ventilation, Respiratory variability, Esophageal pressure, EIT, Respiratory effort
Plan
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