Pressure vs. Volume Control Ventilation Is one safer than the other?

Patrick Gleason MS4
University of South Carolina
School of Medicine
Modes of Ventilation
Ventilator Induced Lung Injury (VILI)
2 main types of injury:
1. Overdistention
2. Collapse and reexpansion
 VILI is histologically indistinguishable from
 Obesity may be protective at high pressures
Pressure Limited Ventilation
Set Peak Inspiratory Pressure
(PIP) level, I:E ratio,
respiratory rate, applied PEEP,
and FiO2
 Tidal volume is variable from
breath to breath
 No consensus on ideal
 Peak airway pressure is
constant during pressure
limited ventilation
Volume Limited Ventilation
Set peak flow rate, flow pattern, tidal volume,
respiratory rate, PEEP, and FiO2.
 PIP is variable from breath to breath
 Important distinction in the flow patterns:
 Square wave vs. ramp wave
Volume Limited Ventilation – cont.
Pressure vs. Volume
There were no statistically significant differences in
mortality, oxygenation, or work of breathing
Pressure-limited ventilation was associated with lower
peak airway pressures, a more homogeneous gas
distribution, improved patient-ventilator synchrony, and
earlier liberation from mechanical ventilation than
volume-limited ventilation.
Studies comparing pressure-limited and volume-limited
ventilation used a square wave pattern for both modes.
When volume-limited mechanical ventilation with a ramp
wave pattern was compared to pressure-limited
ventilation, lower peak airway pressures were no longer
an advantage of pressure-limited ventilation.
Use PEEP in both pressure and volume limited
ventilation – the higher the PIP, the higher the
 Tidal volumes should be between 5-10 mL/kg
of IBW
 Preferable to use either pressure limited or
volume limited with ramp wave flow
 Previous pulmonary injury increases risk for
subsequent VILI
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