Advantages and Rationale for Pressure Controlled Ventilation

  • J. Kesecioglu
  • D. Tibboel
  • B. Lachmann
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1994 book series (YEARBOOK, volume 1994)


Ashbaugh and colleagues [1] in 1969 have used low levels positive end-expiratory pressure (PEEP) with volume controlled ventilation (VCV) (5–10 cm H2O) in the treatment of hypoxemia in adult respiratory distress syndrome (ARDS). They also indicated that higher levels of PEEP could cause barotrauma, decrease cardiac output and therefore decrease O2 transport although PaO2 is increased. Falke and coworkers [2] defined in 1972 the “optimal PEEP” as a level of PEEP which provided a PaO2 > 100 mm Hg with FiO2 ≤0.5. In 1975, Suter and colleagues [3] accepted the “optimal PEEP” as a value providing best oxygen transport and lung compliance, which could be obtained with a PEEP level up to 12 cm H2O. Application of PEEP has been reported to lower cardiac output [3, 4]. However, Qvist et al. [5] demonstrated in 1975 that the adverse hemodynamic effects of PEEP could be limited by additional fluid administration.


Adult Respiratory Distress Syndrome Lung Lavage Pressure Control Ventilation Hyaline Membrane Disease Volume Control Ventilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ashbaugh DG, Petty TL, Bigelow DB, Harris TM (1969) Continuous positive-pressure breathing (CPPB) in adult respiratory distress syndrome. J Thorac Cardiovasc Surg 57: 31–41PubMedGoogle Scholar
  2. 2.
    Falke KJ, Pontoppidan H, Kumar A, Leith DE, Geffin B, Laver MB (1972) Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 51: 2315–2323PubMedCrossRefGoogle Scholar
  3. 3.
    Suter PM, Fairley HB, Isenberg MD (1975) Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 292: 284–289PubMedCrossRefGoogle Scholar
  4. 4.
    Lutch JS, Murray JF (1972) Continuous positive pressure ventilation: Effects on systemic oxygen transport and tissue oxygenation. Ann Intern Med 76: 193–202PubMedGoogle Scholar
  5. 5.
    Qvist J, Pontoppidan H, Wilson RS, Lowenstein E, Laver MB (1975) Hemodynamic responses to mechanical ventilation with PEEP: The effect of hypervolemia. Anesthesiology 42: 45–55PubMedCrossRefGoogle Scholar
  6. 6.
    Reynolds EOR (1971) Effect of alterations in mechanical ventilator settings on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child 46: 152–159PubMedCrossRefGoogle Scholar
  7. 7.
    Lachmann B, Johnson B, Lindroth M, Robertson B (1982) Modes of artificial ventilation in severe respiratory distress syndrome. Lung function and morphology in rabbits after washout of alveolar surfactant. Crit Care Med 10: 724–732PubMedCrossRefGoogle Scholar
  8. 8.
    Lachmann B, Danzmann E, Haendly B, Jonson B (1982) Ventilator settings and gas exchange in respiratory distress syndrome. In: Prakash O (ed) Applied physiology in clinical respiratory care. Martinus Nijhoff Publishers, The Hague, pp 141–176Google Scholar
  9. 9.
    Lachmann B, Haendly B, Schultz H (1980) Improved oxygenation, CO2 elimination, compliance and decreased barotrauma following changes of volume-generated PEEP ventilation with inspiratory/expiratory (I/E) ratio of 1/2 to pressure-generated ventilation with I/E ratio of 4/1 in patients with severe adult respiratory distress syndrome ( ARDS ). Intensive Care Med 6: 64Google Scholar
  10. 10.
    Andersen JB (1986) Changing ventilatory strategy may alter outcome in catastrophic lung disease. Intensive Care Med 12: 200Google Scholar
  11. 11.
    Gattinoni L, Pesenti A, Caspani ML, et al (1984) The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment. Intensive Care Med 10: 121–126PubMedCrossRefGoogle Scholar
  12. 12.
    Lain DC, DiBenedetto R, Morris SL, Van Nguyen A, Saulters R, Causey D (1989) Pressure control inverse ratio ventilation as a method to reduce peak inspiratory pressure and provide adequate ventilation and oxygenation. Chest 95: 1081–1088PubMedCrossRefGoogle Scholar
  13. 13.
    East TD, Böhm SH, Wallace CJ, et al (1992) A successful computerized protocol for clinical management of pressure control inverse ratio ventilation in ARDS patients. Chest 101: 697–710PubMedCrossRefGoogle Scholar
  14. 14.
    Hickling KG (1990) Ventilatory management of ARDS: Can it affect the outcome? Intensive Care Med 16: 219–226PubMedCrossRefGoogle Scholar
  15. 15.
    Dantzker D (1982) Gas exchange in the adult respiratory distress syndrome. Clin Chest Med 3: 57–67PubMedGoogle Scholar
  16. 16.
    Gattinoni L, Pesenti A, Bombino M, et al (1988) Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69: 824–832PubMedCrossRefGoogle Scholar
  17. 17.
    Lachmann B (1992) Open up the lung and keep the lung open. Intensive Care Med 18: 319–321PubMedCrossRefGoogle Scholar
  18. 18.
    Huygen PE, Gültuna I, Ince C, et al (1993) A new ventilation inhomogeneity index from multiple breath indicator gas washout tests in mechanically ventilated patients. Crit Care Med 21: 1149–1158PubMedCrossRefGoogle Scholar
  19. 19.
    Mead J, Takishima T, Leith D (1970) Stress distribution in lungs: A model of pulmonary elasticity. J Appl Physiol 28: 596–608PubMedGoogle Scholar
  20. 20.
    Reynolds EOR, Taghizadeh A (1974) Improved prognosis of infants mechanically ventilated for hyaline membrane disease. Arch Dis Child 49: 505–515PubMedCrossRefGoogle Scholar
  21. 21.
    Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372–377PubMedCrossRefGoogle Scholar
  22. 22.
    Gattinoni L, Pesenti A, Caspani ML, et al (1986) Low frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256: 881–886PubMedCrossRefGoogle Scholar
  23. 23.
    Slutsky AS (1993) Barotrauma and alveolar recruitment. Intensive Care Med 19: 369–371PubMedCrossRefGoogle Scholar
  24. 24.
    Ackerman NB, Coalson JJ, Kuehl TJ, et al (1984) Pulmonary interstitial emphysema in the premature baboon with hyaline membrane disease. Crit Care Med 12: 512–516PubMedCrossRefGoogle Scholar
  25. 25.
    Stocker JT (1988) Pathology of acute bronchopulmonary dysplasia. In: Bancalari A, Stocker I (eds) Bronchopulmonary dysplasia. Washington, pp 237–278Google Scholar
  26. 26.
    Kesecioglu J, Telci L, Esen F, et al (1992) Evaluation of oxygenation with different modes of ventilation in patients with adult respiratory distress syndrome. Adv Exp Med Biol 317: 901–906PubMedGoogle Scholar
  27. 27.
    Lessard M, Guerot E, Mariette C, Harf A, Lemaire F, Brochard L (1992) Pressure controlled with inverse ratio ventilation in patients with adult respiratory distress syndrome (ARDS). Intensive Care Med 18 (Supp. 2 ) 187 (Abst)CrossRefGoogle Scholar
  28. 28.
    Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304: 387–392PubMedCrossRefGoogle Scholar
  29. 29.
    Pinsky MR, Desmet JM, Vincent JL (1992) Effect of positive end-expiratory pressure on right ventricular function in humans. Am Rev Respir Dis 146: 681–687PubMedGoogle Scholar
  30. 30.
    Falke KJ, Pontoppidan H, Kumar A, Leith DE, Geffin B, Laver MB (1972) Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 51: 2315–2323PubMedCrossRefGoogle Scholar
  31. 31.
    Ellman H, Dembin H (1982) Lack of adverse hemodynamic effects of PEEP in patients with acute respiratory failure. Crit Care Med 10: 706–711PubMedCrossRefGoogle Scholar
  32. 32.
    Cole AG, Weller SF, Sykes MK (1984) Inverse ratio ventilation compared with PEEP in adult respiratory failure. Intensive Care Med 10: 227–232PubMedCrossRefGoogle Scholar
  33. 33.
    Poelaert JI, Vogelaers DP, Colardyn FA (1991) Evaluation of the hemodynamic and respiratory effects of inverse ratio ventilation with a right ventricular ejection fraction catheter. Chest 99: 1445–1449CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • J. Kesecioglu
  • D. Tibboel
  • B. Lachmann

There are no affiliations available

Personalised recommendations