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

Yuri Matusov; Jing Li; Dominique Resuello; Hannah Mathers; Jeffrey C Fried

doi:10.1177/1751143719878969

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

J Intensive Care Soc. 2020 Nov;21(4):305-311. doi: 10.1177/1751143719878969. Epub 2019 Oct 21.

Authors

Yuri Matusov^{1

2}, Jing Li³, Dominique Resuello³, Hannah Mathers⁴, Jeffrey C Fried⁵

Affiliations

¹ Department of Medicine, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Department of Medicine, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
³ Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
⁴ University of California, San Diego School of Medicine, La Jolla, CA, USA.
⁵ Department of Medicine, Pulmonary & Critical Care, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.

Abstract

Purpose: To evaluate the impact of pressure-regulated volume control (PRVC/VC+) use on delivered tidal volumes in patients with acute respiratory distress syndrome (ARDS) or at risk for ARDS.

Materials and methods: Retrospective study of mechanically ventilated adult patients with severe sepsis or septic shock.

Results: A total of 272 patients were divided into patients with recognized ARDS, patients without ARDS, and patients with unrecognized ARDS. Over 90% of patients were ventilated with PRVC on admission, resulting in delivered tidal volumes significantly higher than set tidal volumes among all groups at all time points, even after ARDS recognition (p < 0.001). Tidal volumes were lower for patients with pulmonary sepsis as compared to those with a nonpulmonary origin (p < 0.001).

Conclusions: Using PRVC promotes augmented delivered tidal volumes, often in excess of 6 mL/kg ideal body weight. Correct recognition of ARDS and having pulmonary sepsis improves compliance with low-stretch protocol ventilation.

Keywords: Acute respiratory distress syndrome; adult; artificial; critical care; respiration; sepsis; septic; shock; ventilator-induced lung injury.