2004 OPEN FORUM Abstracts
Comparison of Patient Comfort during Pressure Regulated Volume Control (PRVC) and Assist Control (AC) Mechanical Ventilation
Purpose: Pressure Support Ventilation (PSV) has been reported to be more comfortable than AC during non-invasive positive pressure ventilation. This may be due to the ability of PSV to allow the patient to control rate, flow, volume and pattern. However, patient comfort in these modes and PRVC in intubated patients has not been studied. Our study aimed at determining comfort in these modes in intubated patients.
Methods: Twelve patients who were intubated, stable, and able to mark a line on a 100 mm visual analog scale (VAS) were enrolled in the study. They were being ventilated in PRVC before switching them to PSV and AC for 30 minutes each. AC volume was 8cc/kg and pressure support level was set at (Plateau Pressure-Positive End Expiratory Pressure) to target a minimum tidal volume of 8cc/kg. After each mode, patients were asked to mark their comfort level on the VAS (very comfortable=100, uncomfortable=0). Physiologic parameters were also recorded. Paired t-testing was used to analyze the results.
Results: We report only a subset of the study results here. After analyzing the data, we have found no significant difference in patient perceived comfort between PRVC (mean=61) and AC (mean=68), p=0.37. Also, we didn’t find any statistical difference between the two modes in terms of physiologic parameters including blood pressure, heart rate, respiratory rate, oxygen saturation, mean airway pressure and minute ventilation.
Conclusion: Our data shows that PRVC and AC are not statistically different from each other in terms of patient comfort. Our study is limited by the difficulty in finding mechanically ventilated patients in the medical ICU who are both clinically stable and able to use a VAS to accurately mark their comfort level. In addition, other modes of mechanical ventilation such as volume support, proportional assist, and PSV may potentially be more comfortable than either PRVC or AC.
Clinical Implications: Patient comfort is an essential component of medical critical care. Further studies need to be done with larger study population to compare different modes of mechanical ventilation to find the most comfortable mode for the patient.