Comparison of pressure-regulated volume control ventilation and pressure control ventilation in patients with abdominal compartment syndrome

Abstract

Mechanical ventilation support is commonly required in abdominal compartment syndrome (ACS). In the present study, pressure-regulated volume control ventilation (PRVCV) was compared to pressure control ventilation (PCV) in patients with ACS. The prospective study included 40 patients with ACS who were randomized into the PCV or PRVCV groups and subjected to the different modes of ventilation. After 6 h of ventilation, arterial blood gas, respiratory mechanics and hemodynamics parameters, as well as the intra-abdominal pressure (IAP) and Sequential Organ Failure Assessment (SOFA) scores were calculated. Compared to the PCV mode, mechanical ventilation with PRVCV lead to a significant decrease in the partial pressure of carbon dioxide, the peak inspiratory pressure, the mean inspiratory pressure, the central venous pressure, the heart rate and the extravascular lung water index. In addition, a marked improvement in pH, partial pressure of oxygen, oxygenation index and pulmonary static compliance was noted. However, no significant differences in airway resistance, mean arterial pressure, or IAP and SOFA scores were obtained. In conclusion, the PRVCV mode is better than the PCV mode in ventilation patients with ACS, and should therefore be used as a lung protective strategy. The present study was registered at Chictr.org (no. ChiCTR1800016869).

Keywords: abdominal compartment syndrome; arterial blood gas; hemodynamics; pressure-regulated volume control ventilation; respiratory mechanics.

Figure 1.

Study flow chart including the randomization of patients to the PRVCV and PCV groups. PCV, pressure control ventilation; PRVCV, pressure-regulated volume control ventilation.

Figure 2.

Differences in arterial blood gas parameters between the PRVCV and PCV modes. (A) pH, (B) PaO₂, (C) PaO₂/FiO₂ and (D) PaCO₂. *P<0.05, **P<0.01, ***P<0.001. T0, at the beginning of mechanical ventilation; T1, 6 h after ventilation; PCV, pressure control ventilation; PRVCV, pressure-regulated volume control ventilation; PaO₂, partial pressure of O₂; PaCO₂, partial pressure of CO₂; FiO₂, fraction of inspired O₂.

Figure 3.

Differences in respiratory mechanics (PIP, P_mean, Cst and R) between PRVCV and PCV modes. (A) PIP, (B) P_mean, (C) Cst and (D) R. There was no difference between the two groups in R. *P<0.05, **P<0.01, ***P<0.001. T0, at the beginning of mechanical ventilation; T1, 6 h after ventilation; PCV, pressure control ventilation; PRVCV, pressure-regulated volume control ventilation; PIP, peak inspiratory pressure; P_mean, mean inspiratory pressure; Cst, pulmonary static compliance; R, airway resistance.

Figure 4.

Differences in hemodynamics between PRVCV and PCV modes. (A) HR, (B) MAP, (C) CVP and (D) ELWI. No change was seen in MAP. *P<0.05, **P<0.01, ***P<0.001. T0, at the beginning of mechanical ventilation; T1, 6 h after ventilation; PCV, pressure control ventilation; PRVCV, pressure-regulated volume control ventilation; HR, heart rate; MAP, mean arterial pressure; CVP, central venous pressure; ELWI, extravascular lung water index.

Figure 5.

Comparison of IAP and SOFA scores between PRVCV and PCV modes. (A) IAP and (B) SOFA scores. No significant differences were observed *P<0.05. T0, at the beginning of mechanical ventilation; T1, 6 h after ventilation; PCV, pressure control ventilation; PRVCV, pressure-regulated volume control ventilation; IAP, intra-abdominal pressure; SOFA, Sequential Organ Failure Assessment.