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Randomized Controlled Trial
. 2020 Apr 30;69(2):275-282.
doi: 10.33549/physiolres.934122. Epub 2020 Mar 23.

Minute ventilation stabilization during all pressure-control / support mechanical ventilation modes

P Candík  1 , F Depta, S Imrecze, F Sabol, A Kolesar, M Jankajova, M Paulíny, J Benova, K Galková, V Donic, P Török
Affiliations
Randomized Controlled Trial

Minute ventilation stabilization during all pressure-control / support mechanical ventilation modes

P Candík et al. Physiol Res. .

Abstract

The main goal of our prospective randomized study was comparing compare the effectiveness of ventilation control method "Automatic proportional minute ventilation (APMV) "versus manually set pressure control ventilation modes in relationship to lung mechanics and gas exchange. 80 patients undergoing coronary artery bypass grafting (CABG) were randomized into 2 groups. 40 patients in the first group No.1 (APMV group) were ventilated with pressure control (PCV) or pressure support ventilation (PSV) mode with APMV control. The other 40 patients (control group No.2) were ventilated with synchronized intermittent mandatory ventilation (SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control with APMV was able to maintain minute ventilation more precisely in comparison with manual control (p<0.01), similarly deviations of ETCO(2) were significantly lower (p<0.01). The number of manual corrections of ventilation settings was significantly lower when APMV was used (p<0.01). The differences in lung mechanics and hemodynamics were not statistically significant. Ventilation using APMV is more precise in maintaining minute ventilation and gas exchange compared with manual settings. It required less staff intervention, while respiratory system mechanics and hemodynamics are comparable. APMV showed as effective and safe method applicable on top of all pressure control ventilation modes.

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Conflict of interest statement

Conflict of interest

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Basic algorithm of APMV
Fig. 2
Fig. 2
Present measured and target average values in group 1 and 2 of parameters MV and MVs. Measured MV in group 2 showed far higher differences compared with group 1.
Fig. 3
Fig. 3
Showed deviation of MV in percentage (%). We can see that MV in group 1 is more stable (+3.6 to 4.1 %) compared with group 2. (−14.8 to 12.5 %), (p<0.01).
Fig. 4
Fig. 4
Shows differences in average of ETCO2 value between groups 1 and 2. The difference up to 30 minutes of ventilatory onset was not statistically significant (38± 4 mmHg vs 39±7.5). After 45 minutes from onset of ventilation, difference was up to 8 mmHg between both groups (p<0.01) t-test. This mean, that gas exchange in group 1 was more stable compare with group 2. Group 1 linear regresion showed increasing trend of ETCO2 and in group 2 decreasing trend of ETCO2, while both are in acceptable range.
Fig. 5
Fig. 5
Shows the number of events, (with artificial ventilation related intervention), which required staff to come to patients in whole group 1 and 2. 4 times often intervention of nurses and doctors was needed in group 2 compare with group 1 In group 1 no one of 4 interventions was related to ventilation parameters changes (the reason was alarm range setting, trigger sensitivity setting, and patients’ physiological requirements). PaO2/FiO2 was 309±18 mmHg in group 1 and 305±10 mmHg in group 2 (p=NS). Static pulmonary compliance (Cst) in first and last hour of ventilation was 41±10 to 49±13 ml.cm H2O−1 in group 1 vs. 42±7 to 48±15 ml.cm H2O−1 in group 2 (p=NS). We didn’t find any statistically significant difference in airway resistance (Raw), that was 3.1±0.44 cmH2O.l−1.s−1 (P=NS). After resuming of spontaneous ventilation in PSV mode, the respiratory frequency was 15.5±2.9 breaths/min and 16±3.1 breaths/min in group 1 and 2 respectively (p=NS).
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