title: Is pressure-regulated volume control mode appropriate for severely obstructed patients?
abstract: OBJECTIVE
  Management of mechanical ventilation in severely obstructed patients remains controversial. Pressure-regulated volume control ventilation (PRVCV) has been suggested to be the best option, as it should ensure a prefixed tidal volume at the lowest peak inspiratory pressure. We sought to determine the accuracy of the delivered volume, compared with the programmed volume, when using PRVCV.
  
  
  METHODS
  Experimental work performing ventilation simulations using volume control ventilation (VCV), PRVCV, and pressure control ventilation (PCV). Each mode was tested at tidal volumes (TVs) of 200 and 500 mL at both low and high airway resistance. Evita XL and Servo-i ventilators were used.
  
  
  RESULTS
  At 200 ml TV with high resistance, volume delivered with Evita XL was 165 mL (95% confidence interval, 158-169) in VCV, 117 mL (95% confidence interval, 117-120) in PCV, and 120 (95% confidence interval, 115-121) in PRVCV (P<.001). Volume delivered with Servo-i was 133 mL (95% confidence interval, 130-136) in VCV, 108 mL (95% confidence interval, 104-111) in PCV, and 104 (95% confidence interval, 101-108) in PRVCV (P<.001).
  
  
  CONCLUSIONS
  In high-resistance simulations, the delivered volume was lower when using PCV or PRVCV modes than VCV mode. Pressure control ventilation or PRVCV may fail to provide programmed TV, ultimately leading to hypoventilation of the patient.
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain. Electronic address: amedinavillanueva@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Medina
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Modesto-Alapont
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lobete
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Vidal-Micó
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Álvarez-Caro
authors.affiliation: Paediatric Intensive Care Unit, Hospital San Juan de Dios, Barcelona, Spain.
authors.forename: Martí
authors.initials: M
authors.lastname: Pons-Odena
authors.affiliation: Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Mayordomo-Colunga
authors.affiliation: Paediatric Intensive Care Unit, Hospital San Juan de Dios, Barcelona, Spain.
authors.forename: Emili
authors.initials: E
authors.lastname: Ibiza-Palacios
mesh_terms: D000403:Airway Resistance / Q000502:physiology*; D001249:Asthma / Q000503:physiopathology / Q000628:therapy; D016001:Confidence Intervals; D008170:Lung Compliance / Q000502:physiology; D011312:Pressure; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D013990:Tidal Volume / Q000502:physiology; D014939:Work of Breathing / Q000502:physiology*
keywords: Airway resistance; Asthma; Bronchiolitis; Hypoventilation; Mechanical ventilation; Tidal volume