Limitations

A number of limitations make pressure-controlled ventilation less commonly used than volume control. This mode is not available on all ventilators, although most newer models offer pressure-preset ventilation. Because of the complexities of the interactions between ventilator settings (preset pressure, I:E ratio, rate) and patient factors (thoracic compliance, airways resistance, intrinsic PEEP) with this mode of ventilatory support, significant experience on the part of the clinician is required.

The physician should be aware of specific potential complications which require monitoring. Tidal volume, and therefore minute volume, may vary with changes in ventilator settings, clinical condition, or patient-ventilator dyssynchrony. Thus monitoring of these variables is essential. Pressure-regulated volume-controlled ventilation is a mode which attempts to overcome this concern by adjusting pressure to maintain adequate tidal volume. The development of intrinsic PEEP, particularly in inverse ratio ventilation, may have significant adverse hemodynamic effects, reducing filling pressures and cardiac output. In addition, high intrinsic PEEP may reduce tidal pressure and thus minute ventilation, as well as predisposing to barotrauma. Hypercapnia may be an unavoidable consequence of pressure-controlled ventilation, but this is usually well tolerated. As some patients do not tolerate inverse ratio ventilation, deep sedation or even paralysis may be required with their own inherent complications.

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