Comparative analysis of Volume Controlled Ventilation (VCV), Pressure Controlled Ventilation (PCV) and Pressure-Regulated Volume-Control (PRVC) ventilatory modes on ventilatory mechanics, mechanical ventilation time, ICU hospitalization and survival in neurological patients
DOI:
https://doi.org/10.33448/rsd-v11i13.34943Keywords:
Ventilators mechanical; Respiratory therapy; Critical care; Brain injuries; Stroke; Craniocerebral traumas.Abstract
Objectives: To compare the outcome of VCV, PCV and PRVC ventilation modes in relation to ventilatory mechanics, mechanical ventilation time, ICU length of stay and survival in neurological patients. Methods: Randomized cohort study comparing three ventilation modalities VCV, PCV and PRVC in neurological patients diagnosed with ischemic or hemorrhagic stroke and TBI, mechanically ventilated and admitted to the ICU. The mechanical ventilator was adjusted according to the selected mode and with ventilation parameters adjusted to maintain a tidal volume of 6 to 8 ml/kg and blood gas parameters within the normal range. Demographic data, hemodynamic, blood gas and ventilatory parameters and the APACHE II, RASS and Glasgow scales were collected. At the end of the protocol, mortality/survival data, length of stay in the ICU and discharge from the unit were recorded. Results: The PVC group had a longer time of permanence in assisted controlled ventilation in relation to the VCV and PRVC groups (p=0.04). In addition, the PCV group had longer mechanical ventilation (p=0.002), longer ICU stay (p=0.01). Still, there was no difference between the groups in terms of survival, the VCV and PRVC groups showed a trend towards survival when compared to PCV (p=0.4). Finally, there was no difference between the groups in terms of clinical characteristics, ventilatory mechanics and blood gases. Conclusion: Neurological patients should be mechanically ventilated preferably in VCV and PRVC mode, as these modes have advantages over PCV mode in neurological patients.
References
Aghadavoudi O., Alikiaii B. & Sadeghi F. (2016). Comparison of respiratory and hemodynamic stability in patients with traumatic brain injury ventilated by two ventilator modes: Pressure regulated volume control versus synchronized intermittent mechanical ventilation. Adv Biomed Res. Nov 28;5:175. doi: 10.4103/2277-9175.190991. PMID: 28028515; PMCID: PMC5156968.
Almeida M. R., Horta J. G. Á., de Matos N. A., de Souza A. B. F., de Freitas C. T., da Silva C. L., et al. (2020). The effects of different ventilatory modes in female adult rats submitted to mechanical ventilation. Respiratory Physiology & Neurobiology; 103583.
Amato M. B. P., Meade M. O., Slutsky A. S., Brochard L., Costa E. L. V., Schoenfeld D. A. ... Brower R. G. (2015). Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med. 372(8):747–55.
Anderson C. D., Bartscher J. F., Scripko P. D., Biffi A., Chase D., Guanci M. & Greer D. M. (2011). Neurologic examination and extubation outcome in the neurocritical care unit. Neurocrit Care. Dec;15(3):490-7. doi: 10.1007/s12028-010-9369-7. PMID: 20428967.
Asehnoune K., Mrozek S., Perrigault P. F., Seguin P., Dahyot-Fizelier C., Lasocki S., ... The BI-VILI study group. (2017). A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project. Intensive Care Med 43, 957–970. https://doi.org/10.1007/s00134-017-4764-6.
Asehnoune K., Roquilly A. & Cinotti R. (2018). Respiratory Management in Patients with Severe Brain Injury. Crit Care 22, 76. https://doi.org/10.1186/s13054-018-1994-0.
Beitler J. R., Malhotra A. & Thompson B. T. (2016). Ventilator-induced Lung Injury. Clin Chest Med. Dec;37(4):633-646. doi: 10.1016/j.ccm.2016.07.004. Epub 2016 Oct 14. PMID: 27842744; PMCID: PMC5131805.
Bensenor I. M., Goulart A. C., Szwarcwald C. L., Vieira M. L. F. P., Malta D. C. & Lotufo P. A. (2015). Prevalence of stroke and associated disability in Brazil: National Health Survey - 2013. Arq Neuropsiquiatr.;73(9):746–50.
Borghezan L. D. (2020). "Fatores prognósticos relacionados a ventilação mecânica prolongada." Medicina-Tubarão.
Botelho, T. S., Neto C. D. M., Araujo F. L. C., & Assis S. C. (2016). Epidemiologia do acidente vascular cerebral no Brasil - Epidemiology ofstroke in Brazil. Temas em Saúde Volume 16, Número 2 ISSN 2447-2131 João Pessoa.
Cinotti R., Bouras M., Roquilly A. & Asehnoune K. (2018). Management and weaning from mechanical ventilation in neurologic patients. Ann Transl Med. Oct;6(19):381. doi: 10.21037/atm.2018.08.16. PMID: 30460255; PMCID: PMC6212362.
Dallal, G. E. (2020). Randomization plan generators, 2007. Disponível em: <http://randomization.com/>. Acesso em: 30 de outubro.
Duan J., Bai L., Zhou L., Han X. & Huang S. (2019). Decreasing re-intubation using prophylactic noninvasive ventilation in elderly patients: a propensity-matched study. J Crit Care. 50:77–81.
Estrela, C. (2018). Metodologia científica: ciência, ensino, pesquisa. Artes Médicas.
Fan L., Su Y., Elmadhoun O. A., Zhang Y., Zhang Y., Gao D. ... Chen W. (2015). Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness. Neurol Res. 37(11):1006–14.
Fernando S. M., McIsaac D. I., Rochwerg B., BagShaw S. M., Muscedere J., Munshi L., et al. (2019). Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med 45, 1742–1752. doi.org/10.1007/s00134-019-05795-8.
Godet T, Chabanne R, Marin J, Kauffmann S, Futier E, Pereira B, et al. (2017). Extubation Failure in Brain-injured PatientsRisk Factors and Development of a Prediction Score in a Preliminary Prospective Cohort Study. The Journal of the American Society of Anesthesiologists; 126(1), 104-114.
Godet T., Chabanne R., Marin J., Kauffmann S., Futier E., Pereira B. & Constantin J. M. (2017). Extubation failure in brain-injured patients. Anesthesiology. 126:104–14.
Guldager H., Nielsen S. L., Carl P. & Soerensen M. B. (1997). A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure. Crit Care 1, 75. https://doi.org/10.1186/cc107
III Consenso Brasileiro de Ventilação Mecânica - Desmame e Interrupção da Ventilação Mecânica. J Bras Pneumol 2013.
Kacmarek, R. M.; Stoller, J. K. & Huer, A. J. (2017). Egan’s: Funtamentals of Respiratory Care. 11th ed. St. Missouri: Elsevier.
Kasuya Y., Hargett J. L., Lenhardt R., Heine M. F., Doufas A. G., Remmel K. S., Ramirez, J. A. & Akça, O. (2011). Ventilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes. J Crit Care. Elsevier Inc.; 26(3):273–9.
Knaus W. A., Draper E. A., Wagner D. P. & Zimmerman J. E. (1985). APACHE II: a severity of disease classification system. Vol. 13, Critical care medicine. p. 818–29.
Kumar R. G., Kesinger M. R., Juengst S. B., Brooks M. M., Fabio A., Dams-O'Connor K., et al. (2020). Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury. Journal of Trauma and Acute Care Surgery; 88(4), 491-500.
Marchezini, B. (2020). Ventilação Mecânica, Desmame Ventilatório e Qualidade do Sono em UTI: Revisão Sistemática. Revista Neurociências 28: 1-17.
Miranda M. L., Bersot C. D. A. & Villela N. R. (2013). Sedação, analgesia e bloqueio neuromuscular na unidade de terapia intensiva. Revista Hospital Universitário Pedro Ernesto, 12(3). doi:10.12957/rhupe.2013.7537
Neto A. S., Hemmes S. N. T., Barbas C. S. V., Beiderlinden M., Fernandez-Bustamante A., Futier E., ... Schultz M. J. (2016). Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 4(4):272–80.
Othman M. M., Farid A. M. & Mousa S. A. (2013). Hemodynamic effects of volume-controlled ventilation versus pressure-controlled ventilation in head trauma patients: a prospective crossover pilot study. ICU Director 4.5: 223-231.
Pinto A. (2008) Assessment and management of the patient with impaired consciousness. Found Years.4(4):157–61
Robba C., Bonatti G., Battaglini D., Rocco P. R. M. & Pelosi P. (2019). Mechanical ventilation in patients with acute ischaemic stroke: from pathophysiology to clinical practice. Crit Care 23, 388. https://doi.org/10.1186/s13054-019-2662-8.
Rodrigues T. P., Dias M. A., Hohl A. & Mazzuco T. L. (2016). Bases fisiopatológicas do traumatismo crânioencefálico e insuficiência hipofisária pós-traumática. Biosaúde 10.2: 129-146.
Roquilly A., Cinotti R., Jaber S., Jaber S., Vourc’h M., Pengam F., ... Asehnoune K. (2013). Implementation of an evidence-based extubation readiness bundle in 499 brain-injured patients. a before-after evaluation of a quality improvement project. Am J Respir Crit Care Med 2013; 188:958-66. 10.1164/rccm.201301-0116OC.
Samary C. S., Ramos A. B., Maia L. A., Rocha N. N., Santos C. L., Magalhães R. F. ... Rocco P. R. M. (2018). Focal ischemic stroke leads to lung injury and reduces alveolar macrophage phagocytic capability in rats. Crit Care 22, 249. https://doi.org/10.1186/s13054-018-2164-0
Schirmer-Mikalsen K., Vik A., Skogvoll, Moen K. G., Solheim O. & Klepstad P. (2016). Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care 24, 332–341. https://doi.org/10.1007/s12028-015-0208-8.
Schönhofer B., Geiseler J., Dellweg D., Moerer O., Barchfeld T., Fuchs H. et al. (2014). Prolongiertes Weaning [Prolonged Weaning - S2k-Guideline Published by the German Respiratory Society]. Pneumologie ; 68(1): 19-75, Jan.
Sessler C. N., Gosnell M. S., Grap M. J., Brophy G. M., O’Neal P. V., Keane K. A., Tesoro E. P. & Elswick R. K. (2002). The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 166(10):1338–44.
Slutsky A. S. & Ranieri V. M. (2013). Ventilator-Induced Lung Injury. N Engl J Med. 369(22):2126–36.
Souza L. C. Fisioterapia Intensiva. São Paulo: Atheneu, 2009.
Sykora M., Schönenberger S. & Bösel J. (2016). Critical Care of the Patient with Acute Stroke. In: Grotta J, Albers G, Kasner S, Broderick J, Lo E, Mendelow A, Sacco R, Wong L. Stroke: Pathophysiology, Diagnosis and Management. 6th ed. Elsevier. P. 885–915.
Toker M. K., Altıparmak B., Uysal A. İ. & Demirbilek S. G. (2019). Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position. Revista brasileira de anestesiologia; 69(6), 553-560.
Tucci M. R., Beraldo M. A. & Costa E. L. V. (2011). Lesão pulmonar induzida pelo ventilador. Pulmão RJ. 20(Lim 09):43–8.
Warnke C, Heine A, Müller-Heinrich A, Knaak C, Friesecke S, Obst A, et al. (2020). Predictors of survival after prolonged weaning from mechanical ventilation. Journal of Critical Care 60: 212-217.
Windisch W., Dellweg D., Geiseler J., Westhoff M., Pfeifer M., Suchi S., et al. (2020). Prolonged Weaning from Mechanical Ventilation. Dtsch Arztebl Int. Mar 20;117(12):197-204. doi: 10.3238/arztebl.2020.0197. PMID: 32343653; PMCID: PMC7194302.
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