Comparative Study between Pressure Control Ventilation and Pressure Regulated Volume Targeted Ventilation in Management of Obese Patients with ARDS

Abstract

ARDS is a devastating clinical condition affecting both the medical and surgical patients with a mortality rate reaching 40%. Many triggering causes were identified and many lines of treatment were tried since it was first described in the mid sixties by Asbaugh and his colleagues. ARDS is characterized by marked respiratory failure with hypoxia requiring admission to the ICU and mechanical ventilation in most cases. It is important to the clinician to understand that mechanical ventilation itself can be injurious to the lungs. Different modes of mechanical ventilation exist with specific differences between their triggering mechanisms, methods of delivering positive pressure to the lungs and limiting factors. Many studies were done over the past few decades to identify the best methods to ventilate the lungs of ARDS patients. Lung protective strategy were described by the ARMA trial and proved that ventilating the lungs with lower tidal volumes resulted in lower mortality rate. Obese patients represent a high risk group of patients during mechanical ventilation due to any cause due to their altered physiological and anatomical characteristics like the possibility of difficult intubation, increased risk for pulmonary aspiration, reduced chest wall compliance, reduced FRC and increased basal atelectasis. Our study aimed to compare two modes of ventilation, namely the pressure control ventilation and the relatively newer pressure regulated volume targeted ventilation among this specific population; the obese patients suffering from ARDS. We proved that PRVT ventilation is superior to PCV as it resulted in better oxygenation, higher oxygenation index, lower PIP and higher compliance values during mechanical ventilation. It also