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Patient comfort during pressure support and volume controlled-continuous mandatory ventilation
Alan D Betensley1, Imran Khalid, John Crawford
1Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, K-17, Detroit MI 48202, USA. abetens1@hfhs.org
Respiratory Care
|July 3, 2008
Summary
For intubated patients, pressure-support ventilation (PSV) offers greater comfort than volume-controlled continuous mandatory ventilation (VC-CMV). This study found PSV to be the preferred mechanical ventilation mode for patient comfort.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Mechanical Ventilation
Background:
- Noninvasive ventilation in acute hypercapnic respiratory failure shows pressure-support ventilation (PSV) is more comfortable than volume-controlled continuous mandatory ventilation (VC-CMV).
- Previous studies compared physiological measurements between PSV and VC-CMV in intubated patients, but patient comfort perception remained unquantified in this population.
Purpose of the Study:
- To compare patient comfort levels between pressure-support ventilation (PSV) and volume-controlled, flow-limited, continuous mandatory ventilation (VC-CMV) in intubated, mechanically ventilated patients.
Main Methods:
- A randomized prospective trial was conducted where intubated patients received both PSV and VC-CMV for 30 minutes each, with a 30-minute washout period using pressure-regulated volume-control ventilation (PRVC) in between.
- Pressure support levels were adjusted based on plateau pressure during VC-CMV, targeting a tidal volume of 8 mL/kg minus end-expiratory pressure.
- Patient comfort was assessed using a visual analog scale after each ventilation mode.
Main Results:
- Eleven out of 14 patients reported greater comfort during PSV compared to VC-CMV.
- Mean comfort scores were significantly higher for PSV (83) than for VC-CMV (70) and PRVC (62) (p=0.02 for PSV vs. VC-CMV; p=0.009 for PSV vs. PRVC).
- No significant differences in respiratory rate, blood pressure, heart rate, minute ventilation, or blood oxygen saturation were observed between the ventilation modes.
Conclusions:
- Patients generally experienced superior comfort with PSV compared to VC-CMV and PRVC.
- PSV may be the preferred mechanical ventilation mode for awake, intubated patients due to enhanced comfort.
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