Are there benefits or harm from pressure targeting during lung-protective ventilation?
Mechanically, breath design is usually either flow/volume-targeted or pressure-targeted. Both approaches can effectively provide lung-protective ventilation, but they prioritize different ventilation parameters, so their responses to changing respiratory-system mechanics and patient effort are different. These different response behaviors have advantages and disadvantages that can be important in specific circumstances. Flow/volume targeting guarantees a set minute ventilation but sometimes may be difficult to synchronize with patient effort, and it will not limit inspiratory pressure. In contrast, pressure targeting, with its variable flow, may be easier to synchronize and will limit inspiratory pressure, but it provides no control over delivered volume. Skilled clinicians can maximize benefits and minimize problems with either flow/volume targeting or pressure targeting. Indeed, as is often the case in managing complex life-support devices, it is operator expertise rather than the device design features that most impacts patient outcomes.
MacIntyre
Neil R
NR
Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Box 3911, Durham NC 27710, USA. neil.macintyre@duke.edu
Sessler
Curtis N
CN
D006801:Humans; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy; D015656:Respiratory Mechanics; D013990:Tidal Volume / Q000502:physiology*; D055397:Ventilator-Induced Lung Injury / Q000517:prevention & control*