The outcome of early pressure-controlled inverse ratio ventilation on patients with severe acute respiratory distress syndrome in surgical intensive care unit.
BACKGROUND
Pressure-controlled inverse ratio ventilation (PC-IRV) was used in patients with acute respiratory distress syndrome (ARDS) after failed volume-cycled conventional ratio ventilation (VC-CRV). The aim of this study was to evaluate the outcome of early PC-IRV in severe ARDS.


METHODS
Twenty patients with severe ARDS were switched from VC-CRV to PC-IRV if they failed to maintain SaO(2) >90% by the following criteria: peak inspiratory pressure (PIP) >35 cm H(2)O, FIO(2) = 60%, and positive end-expiratory pressure (PEEP) 10 cm H(2)O.


RESULTS
The values of PIP, mean airway pressure, minute volumes, and lung injury score in VC-CRV were 43.9 +/- 8.0 cm H(2)O, 19.5 +/- 6.4 cm H(2)O, 11.0 +/- 2.1 L/min, and 2.8 +/- 0.2 respectively. In PC-IRV, the corresponding data were 31.8 +/- 5.1 cm H(2)O, 25.4 +/- 4.6 cm H(2)O, 8.3 +/- 0.9 L/min, and 2.5 +/- 0.4. All of these parameters were significantly different. Fifteen patients (75%) survived their intensive care unit stay.


CONCLUSIONS
Early PC-IRV in severe ARDS improves oxygenation, facilitates tapering of high fraction of inspiratory oxygen, and decreases high PEEP or PIP, and then results in the improvement of the patient's outcome.
Wang
Shu-Hui
SH
Critical Care Division, Surgical Department, Changhua Christian Hospital, Taiwan. tasen@gcn.net.tw
Wei
Ta-Sen
TS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome