Pressure-Controlled Ventilation with Permissive Hypercapnia in Severe Adult Respiratory Distress Syndrome / 대한마취과학회지

ABSTRACT

The clinical complex of ARDS includes hypoxemia, hypercapnia, diffuse pulmonary infiltrates on chest radiograph, and depressed pulmonary compliance. Even with improved intensive care, the onset of severe disease with ARDS is associated with high mortality rate of 55% to 85% in an adult population. The etiology of ARDS remains uncertain, although increasing experimental evidence suggests that high inflation pressures may be involved in the pulmonary injury that is associated with ARDS. The use of low volume, pressure limited mechanical ventilation with permissive hypercapnia has been proposed to reduce the mortality rates associated with severe ARDS. Pressure-controlled ventilation has been proposed to recruit closed alveolar units and improve oxygenation through changing the inspiratory flow pattern from a square wave as used with volume-controlled ventilation to a rapidly exponentially decaying curve and through maintaining airway pressure at a constant level throughout the inspiratory phase. We present the case of a severe ARDS patient in whom a specific ventilatory management strategy of low peak inflation pressures and permissive hypercapnia appears to have favorably influenced survival and warrants further clinical evaluation.