Roushdy Dina Zeid, Saad Hossam Ahmed, Soliman Randa Aly, Shehata Mohammed Aly, Fakhir Mohammed Amin
Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egipt.
J Crit Care Med (Targu Mures). 2025 Jul 31;11(3):265-274. doi: 10.2478/jccm-2025-0022. eCollection 2025 Jul.
Mechanical ventilation is fundamental for the management of critically ill patients. The mode of mechanical ventilation may impact the patient in different ways. This study aimed to assess the hemodynamic changes occurring when transitioning between Volume-Controlled Ventilation (VCV) to Variable Pressure Support (VPS) and VCV to Pressure Support (PS) by echocardiography. Also, a comparison between the spontaneous breathing modes in terms of outcomes, specifically, weaning of mechanical ventilation, days on a ventilator, hospital days, and survival, was conducted.
This prospective observational study was conducted on 40 mechanically ventilated patients who showed readiness for weaning from Mechanical ventilation. When transitioning between VCV and VPS in arm A and from VCV to PS in arm B, an echocardiographic assessment (transesophageal echocardiography and transthoracic echocardiography) was performed. Both modes were further compared in terms of weaning and the success of liberation from mechanical ventilation.
By comparing both arms, there was a significant difference in velocity time integral (VTI) and stroke volume (SV) for TEE and TTE with p-values of 0.044, 0.022, and 0.05, 0.059, respectively. Also, the cardiac output (CO) showed a statistically significant difference between both arms with a p-value of 0.04. On the other side, there was no statistically significant difference between both arms in terms of ventilator days (p-value of 0.88), length of stay (p-value of 0.651), weaning trial success (p-value of 0.525), and survival rate (p-value of 0.525).
The study showed that VPS is a promising modality that can be used in place of PS as a weaning mode. It provides better patient comfort and a more physiological way of breath delivery. The study also concluded that TTE and TEE will show similar results in most patients and that both can be used interchangeably.
机械通气是危重症患者管理的基础。机械通气模式可能以不同方式影响患者。本研究旨在通过超声心动图评估从容量控制通气（VCV）转换为可变压力支持（VPS）以及从VCV转换为压力支持（PS）时发生的血流动力学变化。此外，还对自主呼吸模式在结局方面进行了比较，具体而言，比较了机械通气的撤机情况、通气天数、住院天数和生存率。
本前瞻性观察性研究针对40例显示出准备好从机械通气撤机的机械通气患者进行。在A组从VCV转换为VPS以及B组从VCV转换为PS时，进行了超声心动图评估（经食管超声心动图和经胸超声心动图）。还在撤机和机械通气脱机成功方面对两种模式进行了进一步比较。
通过比较两组，经食管超声心动图（TEE）和经胸超声心动图（TTE）的速度时间积分（VTI）和每搏输出量（SV）存在显著差异，p值分别为0.044、0.022和0.05、0.059。此外，心输出量（CO）在两组之间显示出统计学上的显著差异，p值为0.04。另一方面，两组在通气天数（p值为0.88）、住院时间（p值为0.651）、撤机试验成功率（p值为0.525）和生存率（p值为0.525）方面没有统计学上的显著差异。
该研究表明VPS是一种有前景的模式，可作为撤机模式替代PS。它为患者提供了更好的舒适度和更符合生理的呼吸方式。该研究还得出结论，大多数患者中TTE和TEE将显示相似结果，两者可互换使用。
