Lung-protective strategy of acute respiratory distress syndrome: a comparative study between pressure control and volume control

Abstract

Introduction Acute respiratory distress syndrome (ARDS) constitutes a major phenotype of acute hypoxemic respiratory failure. Pressure control (PC) and volume control (VC) modes are used for the management of moderate and severe ARDS. Each mode has its benefits and drawbacks. Aim The aim of this study was to compare lung-protective strategy (LPS) using PC ventilation with LPS using VC ventilation to get the best benefit for those critically ill ARDS patients and to solve the problem of hypoventilation. Patients and methods This prospective, randomized controlled trial was carried out at the respiratory intensive care unit of university hospital during the period from October 2017 to December 2018. The study included 30 patients diagnosed as ARDS according to Berlin definition. Those patients were categorized into two groups: group I is the PC group (15 patients) using the LPS and group II is the VC group (15 patients) using the LPS. Results The mean age was 48.93 ± 9.91 years for the PC group with female predominance (53.3%), while the mean age was 46.11 ± 7.94 for the VC group with male predominance (53.3%). Arterial blood gases showed a significant higher pH and lower PaCO2 in the VC group. Mechanical parameters showed a significant higher VT and VE in the VC group. Weaning and outcome in both groups were successful, while seven of the patients of PC (46.7%) and four of the patients of VC (26.7%) failed extubation and died. Conclusion The authors conclude that both modes are equally effective in improving oxygenation in patients of ARDS, who were ventilated with LPS, while VC achieved better ventilation, higher pH, and lower PCO2 than PC. But it needs strict monitoring of plateau pressure to maintain safety.