Individualized flow-controlled ventilation compared to best clinical practice pressure-controlled ventilation: a...

Area of Science:

• Mechanical Ventilation
• Respiratory Physiology
• Pulmonary Medicine

Background:

• Flow-controlled ventilation (FCV) is a novel method for individualizing mechanical ventilation.
• It uses direct tracheal pressure measurement at constant gas flow during inspiration and expiration.
• This study compared individualized FCV with guideline-conform pressure-controlled ventilation (PCV) in a long-term porcine model.

Purpose of the Study:

• To compare the efficacy of individualized flow-controlled ventilation (FCV) against pressure-controlled ventilation (PCV) during long-term mechanical ventilation.
• To assess the impact of FCV on gas exchange and lung aeration.
• To evaluate the safety of FCV regarding lung overinflation.

Main Methods:

• Anesthetized pigs (n=12) were ventilated for 10 hours with either FCV (n=6) or PCV (n=6).
• FCV settings were individualized using compliance-guided positive end-expiratory pressure (PEEP) and peak pressure (Ppeak) titration.
• PCV was set according to current guidelines, with adjustments for normocapnia and a 1:1 or 1:1.5 inspiration:expiration ratio.

Main Results:

• FCV significantly reduced respiratory minute volume compared to PCV.
• Oxygenation (PaO2) and CO2 removal (PaCO2) were significantly improved with FCV.
• Computed tomography showed reduced non-aerated lung tissue in the FCV group without increased overdistension, despite a higher tidal volume.

Conclusions:

• Individualized FCV is applicable for long-term mechanical ventilation.
• FCV leads to significantly improved gas exchange and lung tissue aeration compared to PCV.
• FCV demonstrates potential for enhanced lung protection without signs of overinflation.