variability of volume

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Dreams

luonut Jessica Roff

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luonut Raimonda Baraldi

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luonut Erick Figueroa

How do we choose to respond to events that are beyond our control?

luonut Adam Kinory

The ventilation mode had an important impact on VT in this study. The risk of VT  6 mL/kg IBW was significantly reduced in APRV and PSV with volume-guaranteed mode. APRV had the highest variability. PSV with guaranteed volume could be tested in patients with ARDS.

Variability of Tidal Volume in Patient-Triggered Mechanical Ventilation in ARDS

Discussion

Our first hypothesis was that in PSV, the effort intensity-related VT will result in greater VT than in other patient-triggered modes because the synchronization between effort and mechanical insufflation is maximal. Present data confirmed this hypothesis, which reflects some clinical experience.

Conclusions

Results

Across Modes According to f and Effort

The mixed-effects model found that modes, f, and effort intensity were significantly associated with VT with a significant interaction between them. Therefore, we split the analysis into 4 subgroups determined by the combination of f and effort intensity

Across ModeS

The distribution of VT over all f, effort, and ARDS categories significantly differed across modes

Methods

Data Analysis

In case of interaction between the covariates, we planned to perform a series of non-parametric or parametric analyses of variance to test the effect of ventilator mode on VT at each f and effort. That means that we planned to perform Kruskal-Wallis non-parametric or one-way analysis of variance, depending on the distribution of VT. For each test, we planned post hoc comparisons with PSV without guaranteed VT, used as the control, by using the Dunn test or Dunnett test, respectively.

Ventilator Settings

Our 6-mL/kg IBW VT target, regardless of sex, was 390 mL. In the Lung Safe study, the set VT averaged 7.8, 7.6, and 7.5 mL/kg IBW (ie, 130, 127, and 125% of the 6-mL/kg IBW in mild, moderate, and severe ARDS, respectively). We applied this percentage point to both the total and set f in the Lung Safe study to compute adjusted total and set f in the present study to maintain an equivalent minute ventilation.

Introduction

Actually, the volume volume control mode, this goal is easy to achieve when the patient receives sedation and neuromuscular blockade. However, once sedation and paralysis are withdrawn following clinical improvement, spontaneous breathing.