Ventilator failure or accidental disconnection can be catastrophic in patients undergoing neuromuscular blockade.
Pressure-regulated volume control (PRVC) ventilation is designed for invasive mechanical ventilation and combines volume and pressure strategies. PRVC delivers a pressure-controlled and tidal volume (VT)–targeted breath using a decelerating flow waveform pattern that allows unrestricted spontaneous breathing with or without pressure support (PS). Setting options, terminology, and abbreviations may be brand specific based on the mechanical ventilator specifications.undefined#ref2">2
PRVC is considered an advanced dual-control or adaptive mode because the ventilator uses both volume and pressure to automatically adjust to the patient’s ventilatory needs breath by breath.1 Pressure, flow, or volume delivery depends on variables such as lung compliance, airway resistance, and respiratory effort.4 The mechanical ventilator delivers the lowest pressure and appropriate flow to meet the set VT target for each delivered breath.1,3 A mandatory rate is set for the patient. The patient may breathe above the set rate. All breaths are patient triggered or time triggered. The ventilator compares volume and pressure values from the previous breath and increases or decreases pressure levels according to tidal or minute ventilation. The pressure level that is delivered is between the set positive end-expiratory pressure (PEEP) and the set upper pressure limit. If the breath delivered does not meet the VT target, the ventilator responds by adjusting the inspiratory pressure up or down accordingly in small increments in the attempt to meet the VT target setting for the next breath (Figure 1).
The pressure available to achieve the VT target setting is generally 5 cm H2O below the set upper pressure limit.1 Consequently, if this set pressure limit is reached before the VT target has been delivered, the ventilator breath is terminated, the pressure limit alarm will sound, and the patient will only receive as much of the set volume as possible given the pressure limit. The ventilator adjusts accordingly for the next delivered breath.
PRVC is a mechanical ventilation, lung-protective strategy used to meet acute respiratory distress syndrome (ARDS) management goals by maximizing alveolar recruitment, patient comfort, and patient-ventilator synchrony, while minimizing the risk of barotrauma or volutrauma.1,4 PRVC can automatically adjust to changes in lung compliance and airway resistance on a breath-by-breath basis. If the patient’s lung compliance decreases or airway resistance increases, the system flow and pressure increase. If lung compliance increases or airway resistance decreases, the system flow and pressure decrease. PRVC provides the comfort and safety of pressure ventilation for patients of all ages with a set target for VT and minute ventilation.
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Setting options, terminology, and abbreviations may be brand specific based on trademarked mechanical ventilator specifications.
The patient may breathe above the set respiratory rate.
If the VT target is not met, the ventilator responds by adjusting the inspiratory pressure up or down accordingly in small increments in the attempt to meet the VT target for the next breath (Figure 1).
Consider 35 cm H2O as the initial setting and lung protective strategy because the ventilator should not allow the pressure to rise higher than 5 cm H2O below the upper pressure limit setting and will signal an alarm.1
Matusov, Y. and others. (2020). Use of pressure-regulated volume control in the first 48 hours of hospitalization of mechanically ventilated patients with sepsis or septic shock, with or without ARDS. Journal of the Intensive Care Society, 21(4), 305-311. doi:10.1177/1751143719878969
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