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The Effects of Ventilatory Mode on Lung Aeration Assessed With Computer Tomography: A Randomized Controlled Study

Intensive Care Units, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Finland, tero.varpula{at}hus.fi

Paivi Valta, MD, PhD

Anesthesiology Unit, Jorvi Hospital, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Finland

Antti Markkola, MD, PhD

Department of Radiology Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Finland

Katriina Pohjanen, MD

Department of Radiology Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Finland

Juha Halavaara, MD, PhD

Department of Radiology Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Finland

Markku Hynynen, MD, PhD

Anesthesiology Unit, Jorvi Hospital

Ville Pettila, MD, PhD

Intensive Care Units

Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. Thirty-seven patients with acute lung injury were studied in a trial comparing APRV or SIMV. Computer-assisted tomography scannings (CT) were performed before randomization and at day 7. The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (—1.4 to 18.62) in the SIMV group (n = 10), (P = .65, difference in mean 4.9%, 95% confidence interval —9.0% to 19.0%). The effects of APRV and SIMV on lung aeration are similar after 7 days of mechanical ventilation.

Key Words: acute lung injury • ventilatory mode • computer tomography • airway pressure release ventilation

This version was published on March 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 2, 122-130 (2009)
DOI: 10.1177/0885066608330098


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