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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Is Pressure Assist-Control Preferred Over Volume Assist-Control Mode for Lung Protective Ventilation in Patients With ARDS? NoPressure Control Is Not Preferred for Ventilation

Neil MacIntyre, MD, FCCP
Author and Funding Information

From the Duke University Medical Center.

Correspondence to: Neil MacIntyre, MD, FCCP, Duke University Medical Center, Durham, NC 27710; e-mail: neil.macintyre@duke.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflict of interest: Dr MacIntyre has served as a consultant to CareFusion of Yorba Linda, California, since 1985.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):290-292. doi:10.1378/chest.11-1052
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Extract

On most modern mechanical ventilators, the gas delivery algorithm is generally one of two types: flow/volume targeting (volume assist-control ventilation [VACV]) or pressure targeting with time or flow cycling (pressure assist-control ventilation [PACV] or pressure support ventilation). With flow/volume targeting, the clinician sets an inspiratory flow along with a volume cycling criteria. Airway pressure is, thus, the dependent variable (ie, varying according to lung mechanics and effort). With pressure targeting, the clinician sets an inspiratory pressure target along with either time or flow cycling criteria. Flow and volume are now the dependent variables (ie, varying with lung mechanics and effort). Changes in compliance, resistance, or patient effort will change airway pressure (but not flow) with flow/volume targeting. In contrast, similar changes in compliance, resistance, or effort will cause a change of flow and tidal volume (Vt) (but not airway pressure) with pressure targeting.

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