Rittayamai Nuttapol, Katsios Christina M, Beloncle François, Friedrich Jan O, Mancebo Jordi, Brochard Laurent
Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Chest. 2015 Aug;148(2):340-355. doi: 10.1378/chest.14-3169.
Mechanical ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes.
We performed a systematic review and meta-analysis to determine whether pressure control-continuous mandatory ventilation (PC-CMV) or pressure control-inverse ratio ventilation (PC-IRV) has demonstrated advantages over volume control-continuous mandatory ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models.
Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes.
The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of ventilation of patients with acute respiratory failure.
机械通气是急性呼吸衰竭管理的基石。容量靶向通气和压力靶向通气均被使用，后一种模式的使用越来越多。我们对这两种呼吸输送类型的生理原理进行了叙述性综述，进行了文献检索，并分析了已发表的模式间比较。
我们进行了一项系统评价和荟萃分析，以确定压力控制-持续强制通气（PC-CMV）或压力控制-反比通气（PC-IRV）是否显示出优于容量控制-持续强制通气（VC-CMV）的优势。采用Cochrane偏倚风险工具评估方法学质量。我们还引入生理标准作为选择研究的质量指标。结局包括顺应性、气体交换、血流动力学、呼吸功和临床结局。使用随机效应模型通过RevMan5完成分析。
34项研究符合纳入标准，许多研究存在高偏倚风险。PC-CMV/PC-IRV与VC-CMV的比较在顺应性或气体交换方面未显示出任何差异，即使是在观察PC-IRV时。计算氧合指数提示PC-IRV的效果较差。在血流动力学、呼吸功或临床结局方面，各模式之间没有差异。
两种模式有不同的工作原理，但临床现有数据并未提示结局有任何差异。我们纳入了所有已识别的试验，增强了普遍性，并试图仅纳入质量足够的生理学研究。然而，纳入的试验规模较小且质量差异很大。这些数据应有助于为急性呼吸衰竭患者打开通气方式的选择。
