PreVENT Trial
- PreVENT Trial
- The Bottom Line on the PreVENT Study
Dominating the Vent Series
- EMCrit Lecture – Dominating the Vent: Part I
- EMCrit Lecture – Dominating the Vent: Part II
- Response to Letters on my Mechanical Ventilation Article in the Ann Emerg Med
PRVC Refs
- A rabbit study1
- PC vs. PRVC in Brain Injury Patients2
- Work of Breathing Analysis
- Small Study demonstrating that you are not getting the Vt you think you are3
- Small Crossover Trial4
Now on to the Podcast
References
1.
Porra L, Bayat S, Malaspinas I, et al. Pressure-regulated volume control vs. volume control ventilation in healthy and injured rabbit lung: An experimental study. Eur J Anaesthesiol. 2016;33(10):767-775. [PubMed]
2.
Schirmer-Mikalsen K, Vik A, Skogvoll E, Moen K, Solheim O, Klepstad P. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care. 2016;24(3):332-341. [PubMed]
3.
Kallet R, Campbell A, Dicker R, Katz J, Mackersie R. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respir Care. 2005;50(12):1623-1631. [PubMed]
4.
Guldager H, Nielsen S, Carl P, Soerensen M. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure. Crit Care. 1997;1(2):75-77. [PubMed]
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Love the post. Thanks for debriding some of the dogma surrounding 6 cc/kg tidal volumes. Most patients can be vented just fine with 8 cc/kg, they won’t explode. Agree that APRV is a bad mode for the lung-injured patient. I did an observational study on autoFlow (the Drager equivalent of APRV – basically same thing) a few years ago. I never followed through with publishing it because I have the attention span of a gnat on meth. This has been eating at my soul because I should get the results out there, so I am resolving to post them &… Read more »
hope you meant PRVC above, not APRV
I worry that this study will be misinterpreted and applied to the wrong groups of patients. We already know that non-ARDS patients can benefit from “low” tidal volumes— 6-8ml/kg in the IMPROVE study: https://www.nejm.org/doi/full/10.1056/NEJMoa1301082 Other patients that do not strictly meet ARDS criteria may also benefit from lower volumes… patients with low P/Fs but single lung injury, patients ventilated for a long time, patients with systemic inflammation/shock at high risk of ARDS. I believe the study data, but from an application perspective wouldn’t it make sense to start everyone off at 6, and move select slightly upwards if necessary? The… Read more »
totally grant your slippery slope argument, hence why I do not say 9-10 is ok even though we can make an inference of that from this study. I say 8 for this exact reason.
Now as to the IMPROVE study, did you look at the methods section?
10-12 Vt but what is much worse, ZEEP
zeep is deadly and it has always been baffling to me why this was standard of care in the OR
You’ll note in PreVENT, the PEEP between the 2 groups were the same.
In Denmark, at least in the Region of Southern Denmark, it is my impression that almost all patients recieve som kind of spontaneous driven ventilatory support whenever possible eg GI-bleeds and intercerebral haemorrages with stable CO2. The Nonseda trial originated here and this might a part of the reason why this is standard. Hence, the discission to “put them on” 4, 6 or 12 ml/kg is less as they are less sedated. By the way it seems as if spontaneous breathing patients without lung injury often take very large tidal volumes with little or even low pressure support. I find… Read more »