Comparison of two ventilation modes and its clinical implications in children
Sachdeva, A. and Chugh, K. (2001) Comparison of two ventilation modes and its clinical implications in children. India Chest Supplement, 2 (6).
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Objective: To compare the two types of volume targeted modes of ventilation in pediatric patients. DESIGN Retrospective case record analysis Subjects and Methods: Retrospective analysis of medical records of children with varied medical illnesses who were ventilated over a 6-month period (July to Dec 2000) was done. Forty-four children were ventilated. Eleven received pressure controlled ventilation and were excluded from the study. Neonates (<1 month), patients who received ventilation in post-cardiorespiratory arrest state and cases where duration of ventilation was less than 24 hours were also excluded from the study. Twenty-eight children received volume targeted ventilation under continuous midazolam and vacuronium infusion. Equal number of patients received conventional volume controlled (VC) ventilation and pressure regulated volume control ventilation (PRVC). Cases received a particular mode depending on the availability of machine, Siemens 900 and Siemens 300. Data including clinical features, biochentistry reports, preventilation ABG and PaO2/Fio2 were recorded. Ventilation parameters and ABG taken after initial stabilization (3-4 hours after admission) were also recorded and compared. Mechanical ventilation was started within 24 hours of admission in 12 cases in PRVC and 11 cases in VC group. Results: There were 14 patients in each groups who received conventional VC and PRVC. Patients characteristics including age, gender, clinical and biochemical parameters and PaO2/FiO2 at admission were comparable. There was no statistically significant (p>0.05) difference in mean (+SD of FiO2 (0.6±0.2, 0.56±0.19), TV (116.9±71.15, 93.5±46.5), PEEP (5.07±1.38, 4.21±1.25) and RR (26.5±6.73,26.5+4.53) in VC and PRVC ventilation modes. PIP (23.14+3.50,20.07±4.15), Ti (0.63±0.17, 0.52±0.06), and MAP (ll±2.90, 9.07±1.59) were statistically high in VC as compared to PRVC IPO.05), while pH, PO2, and PCO2 in the two groups were comparable. The duration of ventilation was also comparable. Seven cases in the PRVC and 3 in VC group developed atelectasis and one in VC and none in PRVC group had pneumothorax. There was no difference in the mortality in the two groups. Conclusion: Lower MAP is generated in PRVC mode than with conventional VC mode to achieve same level of ventilation without altering the duration of ventilation or mortality. There is a need to perform prospective randomized study in a large sample.
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