Pressure-controlled ventilation in ARDS: a practical approach.
Patients with ARDS typically have functionally small lungs. A growing body of clinical and experimental evidence has demonstrated that mechanical ventilation that results in high transpulmonary pressure gradients and overdistention of lung units will potentiate the acute lung injury in patients with ARDS. A relative form of "lung rest" using low tidal volume mechanical ventilation that prevents alveolar overdistention has therefore been advocated. This may be achieved with low-volume, volume-cycled ventilation with a decelerating inspiratory flow or pressure-controlled ventilation (PCV). The goal of this article is to provide a simple and practical approach to the management of PCV in patients with ARDS. Implicit in our approach is the use of a ventilator with PCV software and waveform capabilities.
Marik
P E
PE
Department of Critical Care Medicine, St. Vincent Hospital, and the University of Massachusetts Medical School, Worcester 01604, USA.
Krikorian
J
J
D000403:Airway Resistance / Q000502:physiology; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008168:Lung / Q000503:physiopathology; D008170:Lung Compliance / Q000502:physiology; D055370:Lung Injury; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D011650:Pulmonary Alveoli / Q000293:injuries / Q000503:physiopathology; D012123:Pulmonary Ventilation / Q000502:physiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D012984:Software; D013990:Tidal Volume / Q000502:physiology; D013997:Time Factors; D012122:Ventilators, Mechanical