The FlightBridgeED Podcast E14: Pressure Control: PRVC Modes of Ventilation
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Feb 11, 2013 Delve into the nuances of pressure-controlled ventilation modes with an expert's insights. Discover why these modes are crucial for lung protection and learn practical step-by-step strategies for implementation. Explore a complex ICU case involving ARDS and sepsis while uncovering the challenges of current ventilator settings. Gain a clear understanding of PRVC and its advantages, while also being warned about potential risks. This conversation is bursting with vital knowledge for better patient outcomes.
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Chaotic ARDS Transfer Case
- Eric Bauer describes arriving to a rural transfer patient with H1N1, ARDS, and a plateau pressure of 38 mmHg while hypotensive and hypoxic.
- The case illustrates common ICU transfer problems: wrong mode, high Vt, poor sedation, and severe gas-exchange derangement.
Lower Tidal Volume First
- Reduce tidal volume immediately to lung-protective ranges (4–6 mL/kg) to lower plateau pressure risk.
- Recheck plateau pressure after each change using an inspiratory hold to guide further reductions.
Pressure Modes Are Compliance-Driven
- Pressure-control modes base delivered volume on lung compliance rather than a fixed set volume.
- That makes pressure modes gentler for fragile lungs but requires close monitoring of minute ventilation.