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Pressure-Regulated Volume Control and Pressure-Control Ventilation Modes in Pediatric Acute Respiratory Failure
Hasan Serdar Kıhtır1, Nihal Akçay2, Esra Şevketoğlu2
1Department of Pediatric Critical Care, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
Insights
Pressure-control ventilation (PCV) and pressure-regulated volume control (PRVC) modes were compared in pediatric acute respiratory failure. No significant differences in outcomes were found, though PRVC may be safer for inexperienced physicians.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Acute respiratory failure (ARF) is a common critical illness in children.
- Mechanical ventilation is a cornerstone of ARF management.
- Pressure-control ventilation (PCV) and pressure-regulated volume control (PRVC) are distinct modes used in pediatric ARF.
Purpose of the Study:
- To present clinical experience with PCV and PRVC in pediatric patients.
- To compare the efficacy and safety of PCV versus PRVC in children with ARF.
Main Methods:
- Retrospective evaluation of pediatric patients with ARF requiring mechanical ventilation.
- Patients were ventilated using either PCV or PRVC modes.
- Data collected included ventilation parameters, SpO2, blood gases, and demographic information.
Main Results:
- Sixty-one children were analyzed; PCV was used in 65.6% and PRVC in 34.4%.
- Higher positive end-expiratory pressure was observed with PCV (P < .001).
- Hypoxic respiratory failure, low nadir pH, and base excess were associated with increased mortality.
Conclusions:
- No significant differences in pediatric intensive care unit stay, mechanical ventilation duration, or mortality were found between PCV and PRVC.
- PCV was more frequently used in hypoxemic respiratory failure, while both modes were used similarly in hypercapnic cases.
- PRVC may be a safer alternative for clinicians less experienced with PCV.
Objective:
The objective of this study is to present our experience using the pressure-regulated volume control and the pressure-control ventilation modes in children.
Methods:
Patients with acute respiratory failure ventilated with pressure-regulated volume control or pressure-control modes were retrospectively evaluated. The patient's ventilation parameters (of the first 7 days of ventilation or of the whole ventilation period, if the patient had been ventilated less than 7 days), SpO2, blood gases, and demographic data were collected from the pediatric intensive care unit database.
Results:
Sixty-one patients (median age 12 [4.8-36.4] months) were enrolled in the study. The pressure-control ventilation mode was used on 40 patients (65.6%) and the pressure-regulated volume-control mode was used on 21 (34.4%) patients. Twenty-eight patients (45.9%) had hypoxemic respiratory failure and 44 (72.1%) had hypercapnic respiratory failure. The median positive end-expiratory pressure was higher in pressure-control ventilation mode (5.4 [4.2-6.3] cmH2O) than the pressure-regulated volume-control mode (4.05 [3.68-4.41] H2O, P < .001). Pressure-control mode was used more frequently in hypoxemic cases but both modes were used equally in hypercapnic cases. Hypoxic respiratory failure (yes/no), odds ratio: 3.9 (95% CI 1.2-12.3, P=.02), Ph (nadir), odds ratio: 0.004 (95% CI 0.000-0.275, P=.01), and base excess, odds ratio: 0.88 (95% CI 0.79-0.98, P=.02) were associated with intensive care mortality.
Conclusions:
Although the pressure-control ventilation mode was preferred more frequently in hypoxemic respiratory failure, there was no significant difference between the 2 respiratory modes in terms of length of pediatric intensive care unit stay, MV duration, and mortality. The pressure-regulated volume-control mode seems to be a safer option for physicians who do not have enough experience in using pressurecontrol ventilation mode.
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