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Controlled Modes

  • Jean-Michel Arnal
Chapter

Abstract

In volume control mode, inspiratory pressure curve shows the resistances and compliance of the respiratory system and suggests tidal recruitment or tidal lung overdistension. Plateau pressure is measured by an end-inspiratory occlusion to assess end-inspiratory alveolar pressure. There are several pitfalls in interpreting end-inspiratory occlusion curve. Driving pressure is another important variable to monitor. In pressure control mode, inspiratory flow curve depends on the time constant of the respiratory system. It is used to optimize inspiratory time. Plateau pressure and driving pressure are also important to monitor.

Supplementary material

Video 2.1

Pressure curve in VC (AVI 235029 kb)

Video 2.2

Flow pattern in VC (AVI 516134 kb)

Video 2.3

End-inspiratory occlusion in VC (AVI 179727 kb)

Video 2.4

Driving pressure in VC (AVI 315671 kb)

Video 2.5

Flow curve in PC (AVI 435490 kb)

Video 2.6

Inspiratory time in PC (AVI 813376 kb)

Video 2.7

End-inspiratory occlusion in PC with end-inspiratory flow at zero (AVI 200463 kb)

Video 2.8

End-inspiratory occlusion in PC with end-inspiratory flow positive (AVI 205073 kb)

Video 2.9

Driving pressure in PC (AVI 313368 kb)

Suggested Reading

  1. Amato MB, Meade MO, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–55.CrossRefPubMedGoogle Scholar
  2. Baedorf Kassis E, Loring SH, et al. Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS. Intensive Care Med. 2016;42:1206–13.CrossRefPubMedGoogle Scholar
  3. Barberis L, Manno E, et al. Effect of end-inspiratory pause duration on plateau pressure in mechanically ventilated patients. Intensive Care Med. 2003;29:130–4.CrossRefPubMedGoogle Scholar
  4. Bigatello LM, Davignon KR, et al. Respiratory mechanics and ventilator waveforms in the patient with acute lung injury. Respir Care. 2005;50:235–45.PubMedGoogle Scholar
  5. Chiumello D, Carlesso E, et al. Airway driving pressure and lung stress in ARDS patients. Crit Care. 2016;20:276.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Dhand R. Ventilator graphics and respiratory mechanics in the patient with obstructive lung disease. Respir Care. 2005;50:246–61.PubMedGoogle Scholar
  7. Fernández-Pérez ER, Hubmayr RD. Interpretation of airway pressure waveforms. Intensive Care Med. 2006;32:658–9.CrossRefPubMedGoogle Scholar
  8. Guérin C, Papazian L, et al. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016;20:384.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Iotti G, Braschi A. Measurement of respiratory mechanics during mechanical ventilation. Rhäzüns, Switzerland: Hamilton Medical Scientific Library; 1999.Google Scholar
  10. Laffey JG, Bellani G, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016;42:1865–76.CrossRefPubMedGoogle Scholar
  11. Marini JJ, Ravenscraft SA. Mean airway pressure: physiologic determinants and clinical importance--part 1: physiologic determinants and measurements. Crit Care Med. 1992a;20:1461–72.CrossRefPubMedGoogle Scholar
  12. Marini JJ, Ravenscraft SA. Mean airway pressure: physiologic determinants and clinical importance-- part 2: clinical implications. Crit Care Med. 1992b;20:1604–16.CrossRefPubMedGoogle Scholar
  13. Neto AS, Hemmes SN, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4:272–80.CrossRefPubMedGoogle Scholar
  14. Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;50:202–34.PubMedGoogle Scholar
  15. Ranieri VM, Zhang H, et al. Pressure-time curve predicts minimally injurious ventilatory strategy in an isolated rat lung model. Anesthesiology. 2000;93:1320–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Jean-Michel Arnal
    • 1
    • 2
  1. 1.Service de Réanimation PolyvalenteHopital Sainte MusseToulonFrance
  2. 2.Applied Research and New TechnologyHamilton Medical AGBonaduzSwitzerland

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