A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure.
BACKGROUND
COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects.


OBJECTIVE
We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure.


METHODS
Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation - volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2-4 hours and 48 hours.


RESULTS
Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2-4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2-4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2-4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05).


CONCLUSIONS
Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation - volume control.
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Suchi
S
Chang
Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, People's Republic of China.
Jindong
J
Shi
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Cuiping
C
Fu
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Xu
X
Wu
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Shanqun
S
Li
D000367:Age Factors; D000369:Aged, 80 and over; D001469:Barotrauma / Q000209:etiology / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood; D002681:China; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D012307:Risk Factors; D016896:Treatment Outcome; D055397:Ventilator-Induced Lung Injury / Q000209:etiology / Q000517:prevention & control
D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen
COPD; invasive mechanical ventilation; pressure-regulated volume control; respiratory failure; synchronized intermittent mandatory ventilation