Department of Health Professions, Youngstown State University, Youngstown, Ohio, USA.
Respir Care. 2012 Aug;57(8):1297-304. doi: 10.4187/respcare.01529. Epub 2012 Feb 17.
Technological advances have increased ventilator mode complexity and risk of operator error.
To compare differences in volume control (VC) ventilation with set-point and dual targeting. Two hypotheses were tested: tidal volume (V(T)) delivery is different with VC using set-point versus dual targeting during active versus passive breathing; VC with dual targeting delivers V(T) similar to pressure support ventilation (PS) with active breathing.
The Ingmar Medical ASL 5000 lung model simulated pulmonary mechanics of an adult patient with ARDS during active and passive ventilation. Resistance was standardized at 10 cm H(2)O/L/s and compliance at 32 mL/cm H(2)O. Active breathing was simulated by setting the frequency (f) = 26 breaths/min, and adjusting the muscle pressure (P(mus)) to produce a V(T) of 384 mL. VC was initiated with the Puritan Bennett 840 (set-point targeting) and the Servo-i (dual targeting) at V(T) = 430 mL, mandatory f = 15 breaths/min, and PEEP = 10 cm H(2)O. During PS, cycle threshold was set to 30% and peak inspiratory pressure adjusted to produce a V(T) similar to that delivered during VC. Expiratory V(T) was collected on 10 consecutive breaths during active and passive breathing with VC and PS. Mean V(T) differences (active vs passive model) were compared using analysis of variance. Statistical significance was established at P < .05.
The mean ± SD V(T) difference varied with targeting schemes: VC set-point = 37.3 ± 3.5 mL, VC-dual = 77.1 ± 3.3 mL, and PS = 406.1 ± 1.5 mL (P < .001). Auto-triggering occurred during VC set-point with the active model.
Dual targeting during VC allows increased V(T), compared to set-point, but not as much as PS.
技术进步增加了呼吸机模式的复杂性和操作人员失误的风险。
比较设定点和双重目标在容量控制（VC）通气中的差异。提出了两个假设：在主动和被动呼吸期间，使用设定点与双重目标的 VC 输送潮气量（V（T））不同；使用双重目标的 VC 输送 V（T）与主动呼吸时的压力支持通气（PS）相似。
Ingmar Medical ASL 5000 肺模型在主动和被动通气期间模拟成人 ARDS 患者的肺力学。阻力标准化为 10 cm H（2）O/L/s，顺应性为 32 mL/cm H（2）O。通过设置频率（f）= 26 次/分钟并调整肌肉压力（P（mus））来模拟主动呼吸，以产生 384 mL 的 V（T）。VC 由 Puritan Bennett 840（设定点靶向）和 Servo-i（双重靶向）在 V（T）= 430 mL、强制 f = 15 次/分钟和 PEEP = 10 cm H（2）O 时启动。在 PS 期间，将循环阈值设置为 30%，并调整吸气峰压以产生与 VC 输送时相似的 V（T）。在主动和被动通气期间，使用 VC 和 PS 收集 10 次连续呼吸的呼气 V（T）。使用方差分析比较主动与被动模型之间的平均 V（T）差异。P<.05 表示具有统计学意义。
两种靶向方案的平均±SD V（T）差异不同：VC 设定点= 37.3±3.5 mL，VC 双重= 77.1±3.3 mL，PS = 406.1±1.5 mL（P<.001）。在主动模型中，VC 设定点发生自动触发。
与设定点相比，VC 双重目标可增加 V（T），但不如 PS 增加得多。
