Respiratory mechanics analysis in neurocritical patients admitted to a general icu ventilated in prvc, pcv and vcv modes

Authors

  • Gabriela dos Santos Martins Universidade Federal do Pampa - Unipampa, Rio Grande do Sul, (Brasil)
  • Daniéle Nunes Stecker Universidade Federal do Pampa - Unipampa, Rio Grande do Sul, (Brasil)
  • Daniela Martins de Fausto Centro Universitário Adventista de São Paulo - UNASP, São Paulo, (Brasil)
  • Antonio Adolfo Mattos de Castro Universidade Federal do Pampa - Unipampa, Rio Grande do Sul, (Brasil)

DOI:

https://doi.org/10.19141/2237-3756.lifestyle.v11.n00.pe1419

Keywords:

Neurocritical patients, Ventilatory mechanics, Pressure controlled ventilation, Volume controlled ventilation, Pressure regulated and volume controlled ventilation

Abstract

Objectives: Compare volume controlled (VCV), pressure controlled (PCV) and pressure regulated and volume controlled (PRVC) ventilation modes in relation to ventilatory mechanics in neurocritical patients admitted to an ICU setting.

Methods: Sixteen patients were recruited, they had mean age of 56.1±19.7, had 12.6±9.1 days of hospital length of stay, with 81.2% overall survival. Three groups used different ventilatory modalities: PRVC, PCV and VCV. Patients were ventilated for a tidal volume of 6 to 8 ml/Kg, Glasgow, RASS, PAM, FC, f, FiO2, PEEP, pressure, volume or support pressure, Ppico, Cd, Wr, P0.1, pH, PaCO2, PaO2, HCO3 and SaO2 were measured.

Results: We did not find differences between the initial and final values and between the groups regarding ventilatory mechanics of the 16 patients on mechanical ventilation admitted to the ICU. We found a correlation between respiratory work and peak pressure (r = 0,87; p = 0,02), expiratory resistance and peak pressure (r = 0,91; p = 0,01), static compliance and elastance (r = -0,81; p = 0,04) and work of breathing and inspiratory resistance (r = 1,0, p = 0,003), in the PRVC mode; correlation between peak pressure and dynamic compliance (r = -0,91, p = 0,03) and work of breathing and elastance (r = -0,90, p = 0,03) in the PCV mode; correlation between elastance and static compliance (r = -0,97, p = 0,004) and PaO2/FiO2 ratio and work of breathing (r = 0,99, p = 0,02) in the VCV mode.

Conclusions: There is no difference in ventilatory mechanics parameters when neurocritical patients were mechanically ventilated in PRVC, PCV and VCV modes.

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Author Biography

Antonio Adolfo Mattos de Castro, Universidade Federal do Pampa - Unipampa, Rio Grande do Sul, (Brasil)

Doutor em Medicina (Pneumologia) pela Universidade Federal de São Paulo - UNIFESP, São Paulo, (Brasil). Professor adjunto da Universidade Federal do Pampa - Unipampa, Rio Grande do Sul, (Brasil).

References

ALMEIDA, S. R. M. Análise epidemiológica do Acidente Vascular Cerebral no Brasil. Revista Neurociências, v. 20, n. 4, p. 481–482, 31 dez. 2012. DOI: https://doi.org/10.34024/rnc.2012.v20.8219

AMARAL, J. L. G. Sedação, analgesia e bloqueio neuromuscular em UTI. São Paulo: Atheneu, 1996.

ANDERSON, C. D.; BARTSCHER, J. F.; SCRIPKO, P. D.; BIFFI, A. CHASE, D.; GUANCI, M.; GREER, D. M. Neurologic Examination and Extubation Outcome in the Neurocritical Care Unit. Neurocritical Care, v. 15, n. 3, p. 490–497, 29 dez. 2011. DOI: https://doi.org/10.1007/s12028-010-9369-7

BALICK-WEBER, C. C.; NICOLAS, P.; HEDREVILLE-MONTOUT, M.; BLANCHET, P.; STÉPHAN, F. Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment. British Journal of Anaesthesia, v. 99, n. 3, p. 429–435, set. 2007. DOI: https://doi.org/10.1093/bja/aem166

BARBAS, C. V.; ÍSOLA, A. M.; FARIAS, A. M. C. Diretrizes brasileiras de ventilação mecânica. Associação de Medicina Intensiva Brasileira e Sociedade Brasileira de Pneumologia e Tisiologia, p. 1–140, 2013.

BENSENOR, I. M.; GOULART, A. C.; SZWARCWALD, C. L.; VIEIRA, M. L. F. P.; MALTA, D. C.; LOTUFO, P. A. Prevalence of stroke and associated disability in Brazil: National Health Survey - 2013. Arquivos de Neuro-Psiquiatria, v. 73, n. 9, p. 746–750, set. 2015. DOI: https://doi.org/10.1590/0004-282X20150115

BULLOCK, R. C. R. M.; CHESNUT, R. M.; CLIFTON, G. GHAJAR, J.; MARION, D. W.; NARAYAN, R. K.; NEWELL, D. W.; PITTS, L. H.; ROSNER, M. J.; WILBERGER, J. W. Guidelines for the management of severe head injury. European Journal of Emergency Medicine, v. 3, n. 2, p. 109–127, jun. 1996. DOI: https://doi.org/10.1097/00063110-199606000-00010

CARVALHO, F. A.; BERNARDINO, T.; MACIEL, R. O. H.; FELIZOLA S. F. A.; COSTA, E. L. V.; SILVA, G. S. Central Neurogenic Respiratory Failure: A Challenging Diagnosis. Case Reports in Neurology, v. 3, n. 1, p. 75–81, 23 fev. 2011. DOI: https://doi.org/10.1159/000324823

CHEN, Y. J.; SUNG, S. F.; HSU, Y. C. Central neurogenic hyperventilation in a conscious patient with chronic brain inflammation. Journal of Internal Medicine of Taiwan, v. 24, n. 4, p. 328–333, 2013.

DALLAL, Gerard E. Randomization plan generators, 2007. Disponível em: <http://randomization.com/>. Acesso em: 30 de ago. 2021.

DE SOUZA, L. C.; GUIMARAES, F. S.; LUGON, J. R. The Timed Inspiratory Effort: A Promising Index of Mechanical Ventilation Weaning for Patients With Neurologic or Neuromuscular Diseases. Respiratory Care, v. 60, n. 2, p. 231–238, 1 fev. 2015. DOI: https://doi.org/10.4187/respcare.03393

FAN, L.; SU Y.; ELMADHOUN, O. A.; ZHANG, Y.; ZHANG, Y.; GAO, D.; YE, H.; CHEN, W. Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness. Neurological Research, v. 37, n. 11, p. 1006–1014, 27 nov. 2015. DOI: https://doi.org/10.1179/1743132815Y.0000000092

FIGUEROA-CASAS, J. B.; MONTOYA, R. Difference in inspiratory flow between volume and pressure control ventilation in patients with flow dyssynchrony. Journal of Critical Care, v. 42, p. 264–267, dez. 2017. DOI: https://doi.org/10.1016/j.jcrc.2017.08.007

GAMBAROTO, Gilberto. Fisioterapia respiratória em unidade de terapia intensiva. São Paulo: Atheneu, 2006.

GROTTA, J. C.; ALBERS, G. W.; BRODERICK, J. P.; DAY, A. L.; KASNER, S. E.; LO, E. H.; SACCO, R. L.; WONG, L. K. S. Stroke: Pathophysiology, Diagnosis and Management. Elsevier, 2016. Pages 885–915.e9. 54.

GULDAGER, H.; NIELSEN, S.; CARL, P.; SOERENSEN, M. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure. Critical care (London, England), v. 1, n. 2, p. 75–77, 1997. DOI: https://doi.org/10.1186/cc107

KALLET, R. H.; CAMPBELL, A. R.; DICKER, R. A.; KATZ, J. A.; MACKERSIE, R. C. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respiratory care, v. 50, n. 12, p. 1623–31, dez. 2005.

KASUYA, Y.; HARGETT, J. L.; LENHARDT, R.; HEINE, M. F.; DOUFAS, A. G.; REMMEL, K. S.; RAMIREZ, J. A. Akça, OzanVentilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes. Journal of Critical Care, v. 26, n. 3, p. 273–279, jun. 2011. DOI: https://doi.org/10.1016/j.jcrc.2010.09.006

MASCIA, L.; Zavala, E.; Bosma, K.; Pasero, D.; Decaroli, D.; Andrews, P.; Isnardi, D.; Davi, A.; Arguis, M. J.; Berardino, M.; Ducati, A. High tidal volume is associated with the development of acute lung injury after severe brain injury: An international observational study. Critical Care Medicine, v. 35, n. 8, p. 1815–1820, ago. 2007. DOI: https://doi.org/10.1097/01.CCM.0000275269.77467.DF

OTHMAN, M. M.; FARID, A. M.; MOUSA, S. A.; SULTAN, M. A. Hemodynamic Effects of Volume-Controlled Ventilation Versus Pressure-Controlled Ventilation in Head Trauma Patients. ICU Director, v. 4, n. 5, p. 223–231, 18 set. 2013. DOI: https://doi.org/10.1177/1944451613491491

PELOSI, P.; SEVERGNINI, P.; CHIARANDA, M. An integrated approach to prevent and treat respiratory failure in brain-injured patients. Current Opinion in Critical Care, v. 11, n. 1, p. 37–42, fev. 2005. DOI: https://doi.org/10.1097/00075198-200502000-00006

PINTO, A. Assessment and management of the patient with impaired consciousness. The Foundation Years, v. 4, n. 4, p. 157–161, ago. 2008. DOI: https://doi.org/10.1016/j.mpfou.2008.05.007

RITTAYAMAI, N.; KATSIOS, C. M.; BELONCLE, F.; FRIEDRICH, J. O.; MANCEBO, J.; BROCHARD, L. Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure. Chest, v. 148, n. 2, p. 340–355, ago. 2015. DOI: https://doi.org/10.1378/chest.14-3169

RODRIGUES, T. P.; DIAS, M. A.; HOHL, A.; MAZZUCO, T. L. Bases fisiopatológicas do traumatismo crânio- encefálico e insuficiência hipofisária pós-traumática. Biosaúde, v. 10, n. 2, p. 129–146, 2008.

SCHIRMER-MIKALSEN, K.; VIK, A.; SKOGVOLL, E.; MOEN, K. G.; SOLHEIM, O.; KLEPSTAD, P. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocritical Care, v. 24, n. 3, p. 332–341, 2016. DOI: https://doi.org/10.1007/s12028-015-0208-8

SESSLER, C. N.; GOSNELL, M. S.; GRAP, M. J.; BROPHY, G. M.; O'NEAL, P. V.; KEANE, K. A.; TESORO, E. P.; ELSWICK, R. K. The Richmond Agitation–Sedation Scale. American Journal of Respiratory and Critical Care Medicine, v. 166, n. 10, p. 1338–1344, 15 nov. 2002. DOI: https://doi.org/10.1164/rccm.2107138

SHEIN, S. L.; SPEICHER, R. H.; ROTTA, A. T. Tratamento atual de crianças com asma crítica e quase fatal. Revista Brasileira de Terapia Intensiva, v. 28, n. 3, p. 358–359, 2016. DOI: https://doi.org/10.5935/0103-507X.20160064

SYKORA, M.; SCHÖNENBERGER, S.; BÖSEL, J. Critical Care of the Patient with Acute Stroke. In: Stroke. [s.l.] Elsevier, 2016. p. 885-915.e9. DOI: https://doi.org/10.1016/B978-0-323-29544-4.00054-2

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Published

2024-02-19

How to Cite

dos Santos Martins, G., Nunes Stecker, D., Martins de Fausto, D., & Mattos de Castro, A. A. (2024). Respiratory mechanics analysis in neurocritical patients admitted to a general icu ventilated in prvc, pcv and vcv modes. Journal of Interdisciplinary Lifestyle Studies, 11(00), e1419. https://doi.org/10.19141/2237-3756.lifestyle.v11.n00.pe1419

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Vol. 11 (2024): Continuous publication

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Artigos

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Copyright (c) 2022 Gabriela, Daniéle, Daniela, Elias, Antonio

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