Clinical Comparison of Volume Support Ventilation With Pressure Support Ventilation in Patients Admitted at Intensive Care Unit
VSV with PSV in patients admitted at ICU
Mechanical ventilation (MV) is among the main basics of supportive treatment for respiratory failure in the intensive care unit (ICU). This supportive treatment may cause undesirable complications that led to the introduction of various MV modes. The current study was aimed to assess and compare outcomes of volume support ventilation (VSV) and pressure support ventilation (PSV) regarding spontaneous breath return, weaning and hemodynamic changes among patients admitted at ICU following surgical procedures. This single-blinded randomized-clinical-trial (RCT) was conducted on 100 patients admitted at ICU in 2018-2019. Patients were randomly divided into two fifty-member groups treated with PSV and VSV modes. Oxygen saturation, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), arterial blood gas (ABG), extubation and MV time and sedation based on RAMSY criteria were recorded and compared. Mean age (P=0.79) and gender distribution (P=0.57) were not statistically different in the two groups. Time has no effect on patients' hemodynamic (P>0.05) while hemodynamic stability was superior in VSV (P<0.05). ABG showed no statistical difference between groups (P>0.05) except for arterial oxygen pressure that was higher in the VSV group (P<0.001). The duration of MV, extubation time and duration of ICU admission was significantly lower in the VSV group. Furthermore, sedation based on RAMSY criteria showed the superiority of VSV (P<0.05). Use of VSV mode was accompanied with superior outcomes in four entities including earlier and easier weaning, shorter duration of ICU admission, least hemodynamic instabilities and least sedation requirement in comparison to PSV mode.
2.Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. The Lancet Respiratory Medicine. 2016; 4(4):272-80.
3.Gattinoni L, Marini JJ, Collino F, Maiolo G, Rapetti F, Tonetti T, et al. The future of mechanical ventilation: lessons from the present and the past. Critical Care. 2017; 21(1):183.
4.Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, et al. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Critical care medicine. 2015; 43(9):1798-806.
5.Dupuis S, Brindamour D, Karzon S, Frenette AJ, Charbonney E, Perreault MM, et al. A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2019; 66(3):318-27.
6. Branson RD, Chatburn RL. Should adaptive pressure control modes be utilized for virtually all patients receiving mechanical ventilation? Respiratory care. 2007; 52(4):478-88.
7. Branson RD, Johannigman JA. What is the evidence base for the newer ventilation modes? Respiratory care. 2004; 49(7):742-60.
8.Jaber S. New dual ventilator modes: are we ready to perform large clinical trials? : Respiratory Care; 2009.
9.Sancar NK, Özcan PE, Şentürk E, Selek Ç, Çakar N. The Comparison of Pressure (PSV) and Volume Support Ventilation (VSV) as a ‘Weaning’Mode. Turkish journal of anaesthesiology and reanimation. 2014; 42(4):170.
10.Hughes CG, McGrane S, Pandharipande PP. Sedation in the intensive care setting. Clinical pharmacology: advances and applications. 2012; 4:53.
11.Rasheed AM, Amirah MF, Abdallah M, Parameaswari P, Issa M, Alharthy A. Ramsay Sedation Scale and Richmond Agitation Sedation Scale: A Cross-sectional Study. Dimensions of Critical Care Nursing. 2019; 38(2):90-5.
12. Fathi HM, Osman DM. Weaning of chronic obstructive pulmonary disease patients after coronary artery bypass graft surgery. Research and Opinion in Anesthesia and Intensive Care. 2018; 5(3):147.
13. Cassina T, Chioléro R, Mauri R, Revelly J-P. Clinical experience with adaptive support ventilation for fast-track cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2003; 17(5):571-5.
14. Petter AH, Chioléro RL, Cassina T, Chassot P-G, Müller XM, Revelly J-P. Automatic “respirator/weaning” with adaptive support ventilation: the effect on duration of endotracheal intubation and patient management. Anesthesia & Analgesia. 2003; 97(6):1743-50.
15. Sulzer CF, Chioléro R, Chassot P-G, Mueller XM, Revelly J-P. Adaptive Support Ventilation for Fast Tracheal Extubation after Cardiac SurgeryA Randomized Controlled Study. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2001; 95(6):1339-45.
16.Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguía C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. American journal of respiratory and critical care medicine. 2011; 184(4):430-7.
17. Epstein S. Complications in ventilator supported patients. Principles and practice of mechanical ventilation. 2006:877-902.
18. Haitsma JJ, Lachmann RA, Lachmann B. Open lung in ARDS. Acta Pharmacologica Sinica. 2003; 24(12):1304-7.
19. Luetz A, Goldmann A, Weber-Carstens S, Spies C. Weaning from mechanical ventilation and sedation. Current Opinion in Anesthesiology. 2012; 25(2):164-9.
20.Chanques G, Kress JP, Pohlman A, Patel S, Poston J, Jaber S, et al. Impact of ventilator adjustment and sedation–analgesia practices on severe asynchrony in patients ventilated in assist-control mode. Critical care medicine. 2013; 41(9):2177-87.
21. Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. The Lancet. 2010; 375(9713):475-80.