Pressure support ventilation vs. synchronized intermittent mandatory ventilation. Hemodynamic effects on critically ill patients

Ventilación asistida por presión vs. ventilación mandatoria intermitente sincronizada. Efectos hemodinámicos en pacientes críticos

Published 2010-01-01

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Vol. 22 No. 4 (2010)
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Research article
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Pressure support ventilation vs. synchronized intermittent mandatory ventilation. Hemodynamic effects on critically ill patients.
rev. colomb. neumol. [Internet]. 2010 Jan. 1 [cited 2024 Dec. 4];22(4):136-42.
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Carmelo Dueñas
Unidad de Cuidado Intensivo. Hospital Bocagrande. Cartagena, Colombia.
    Carlos García Del Río
      Martín Carvajal
        Gloria Olmos Ruiz
          Patricia Vélez
            Show authors biography

            Carmelo Dueñas,

            Universidad de Cartagena, Unidad de Cuidado Intensivo. Hospital Bocagrande. Cartagena, Colombia.

            Background: Several studies about the hemodynamic effects of pressure support ventilation (PSV) have appeared over the past two years. These studies have been carried out on less than 15 patients, and none of them has compared the physiological effects of PSV and synchronized intermittent mandatory ventilation (SIMV) on the same patient.

            Objective: To establish the hemodynamic effects of PSV as compared with those of SIMV.

            Design: Prospective, controlled trial.

            Patients and methods: 31 patients were included in the study, from June 1993 to May 1995. They were distributed at random to be handled with SIMV or assist-control ventilation (ACV) during the stabilization phase. Before initiating the weaning, and after random assignation, the patients were put on PSV or SIMV for two hours (STEP 1), and hemodynamic and arteriovenous blood gas measurements were performed. Thereafter the patients were put on ACV for one hour and then to the other ventilation mode for two more hours (STEP 2), with new measurements performed. A 10cc/Kg variable, FIO2 of 40% and PEEP of 4 were maintained. The variables studied were pulmonary capillary pressure (W), central venous pressure (CVP), cardiac index (CI), oxygen supply (DOS), oxygen consumption (VO2), heart rate, systemic and pulmonary vascular resistances, arterial oxygen saturation (SaO2), and and lung distensibility (D). The results obtained from the total group (n=31) are presented thereafter on the two steps. We then divided this into two subgroups on the basis of the illness.

            Group 1: Systemic inflammatory response syndrome (SIRS): sepsis, ARDS, etc.) and Group 2: Severe cardiac failure (SCF). The statistical analysis was done with average, standard deviation (s), and the variables evaluated were analyzed by means of the Student Tos test (p<0,05) Results: No fundamental differences were found among the 31 patients; the same occurred in the group of patients with SIRS, but when comparing the hemodynamics of the patients with SCF it was found that they had a better CI with PSV than with SIMV. The reason for this could be in that PSV reduces the preload, which could be of benefit in this type of patients. PSV reduces IVO2 because it facilitates ventilator/patient coupling. From the ventilatory point of view, improved
            oxygenation was evident with PSV in all the groups.

            Conclusion: PSV may be considered the method of choice for the management of patients with SHF.

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