Zmiany ciśnienia w tchawicy podczas wentylacji czasowo-zmiennej z kontrolowanym ciśnieniem, kontrolowaną objętością oraz wentylacji z regulowanym ciśnieniem i kontrolowaną objętością u niemowląt

*Andrzej Piotrowski¹, Wojciech Fendler¹, Piotr Czech¹, Wojciech Sobala²

Summary
Background. Pressure controlled ventilation (PCV) has been recognized as an alternative to volume controlled ventilation (VCV) for respiratory distress syndrome. Pressure regulated, volume controlled ventilation (PRVC) is a relatively new method of respiratory support which allows for precise adjustment of tidal volume delivered to the patient, ventilated with a square pressure wave, characteristic of pressure controlled ventilation.
Methods. In the prospective study, we compared the effects of three ventilation modes (PCV, VCV, and PRVC) on the peak inspiratory pressure (PIP) measured within the respiratory circuit and directly in the trachea, and on arterial blood pressure and pulmonary gas exchange. Infants, treated for acute respiratory failure, were ventilated with constant tidal volume, using a Siemens Servo 300 ventilator for 30 min with PCV, VCV or PRVC, in random order. Intratracheal pressure was measured via a pre-cut catheter inserted into the endotracheal tube and connected to the pressure monitor.
Results. 14 infants, aged 3-13 days were enrolled in a trial. Peak inspiratory pressures (PIP), measured within the ventilator circuit, were similar during PCV and PRVC, and were significantly higher during VCV. PIP measured in the trachea was significantly lower during VCV, compared to PCV and PRVC. The lowest values of PaCO₂ were noted during PRVC. PaO₂, HR and arterial blood pressures were similar during all modes of ventilation.
Discussion and conclusion. PIP and PEEP readings from the ventilator manometer were different from those obtained in the trachea. PCV and PRVC provided similar respiratory pressures, and VCV was also acceptable. Further studies are needed to establish the usefulness of PRVC in paediatric intensive care.

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