Mechanical Ventilation in the Critically Ill Obese Patient by Antonio M. Esquinas & Malcolm Lemyze

Author:Antonio M. Esquinas & Malcolm Lemyze
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

17.4.4 Pressure-Controlled Ventilation Volume Guaranteed (PCV-VG)

Pressure-controlled ventilation volume guaranteed (PCV-VG) is a hybrid mode of ventilation in anaesthesia, using time mode, a preset tidal volume but pressure-regulated with variable inspiratory flow. PCV-VG will deliver the preset tidal volume for each breath cycle using the lowest pressure possible and thus in theory minimising the peak inspiratory pressure (PIP). Dion et al. [15] looked at 20 severely obese young patients during laparoscopic-assisted bariatric surgery who received 20 min of ventilation with VCV, PCV or PCV-VG. The main finding from the study was a lower PIP with PCV and PCV-VG modes as compared with VCV. There was no advantage with oxygenation or ventilation between the modes. This was also concluded in a study comparing VCV with PCV-VG where 30 patients undergoing abdominal surgery received PCV for 45 min and then alternating to PCV-VG modes [16]. No difference was found with plateau pressure, mean airway pressure or oxygenation [16]. This went against the authors’ initial hypothesis that the dual mode ventilation may alter the flow pattern improving oxygenation. There was no conclusive reason for this finding. Overall it remains difficult to interpret with small numbers included and the crossover format of the study design.

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