Mechanical Power Differs Between Pressure-Controlled Ventilation and Different Volume-Controlled Ventilation Modes

Petra J Rietveld; Jacob W M Snoep; Marjolein Lamping; Franciska van der Velde; Evert de Jonge; David W van Westerloo; Abraham Schoe

doi:10.1097/CCE.0000000000000741

Mechanical Power Differs Between Pressure-Controlled Ventilation and Different Volume-Controlled Ventilation Modes

Crit Care Explor. 2022 Aug 15;4(8):e0741. doi: 10.1097/CCE.0000000000000741. eCollection 2022 Aug.

Authors

Petra J Rietveld¹, Jacob W M Snoep¹, Marjolein Lamping¹, Franciska van der Velde¹, Evert de Jonge¹, David W van Westerloo¹, Abraham Schoe¹

Affiliation

¹ All authors: Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.

Abstract

Objectives: Mechanical power (MP) is a way of estimating the energy delivered by the ventilator to the patient. For both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) methods have been described to calculate the MP. The pressure-volume (PV) loop, from which the MP is calculated, is different for VCV compared with PCV. We aimed to compare the MP of VCV with zero pause time (VCV-0), VCV with 10% pause time (VCV-10), and PCV within patients in different patient categories based on severity of lung injury.

Design: In a proof-of-concept study, we enrolled 46 mechanically ventilated patients without spontaneous breathing efforts. Baseline measurements were done in pressure-controlled mode. Subsequently, measurements were done in VCV-0 and VCV-10. Tidal volume and all other settings were kept the same.

Setting: ICU, single university medical center.

Patients: Fifty-eight cases in 46 patients on controlled ventilation modes.

Interventions: Comparison between the MP of PCV, VCV-0, and VCV-10.

Measurement and main results: The mean MP of VCV-0, VCV-10, and PCV was 19.30, 21.80, and 20.87 J/min, respectively (p < 0.05 for all comparisons). The transpulmonary MP of VCV-0, VCV-10, and PCV was 6.75, 8.60, and 7.99 J/min, respectively (p < 0.05 for all comparisons).

Conclusions: In patients ventilated in a controlled mode, VCV without pause time had the lowest MP followed by PCV. VCV with 10% pause time had the highest MP.

Keywords: mechanical power; mechanical ventilation; pressure-controlled ventilation; stress and strain of the lung; ventilator-induced lung injury; volume-controlled ventilation.