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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Is Pressure Assist-Control Preferred Over Volume Assist-Control Mode for Lung Protective Ventilation in Patients With ARDS? YesPressure Control Is Preferred for Ventilation

John J. Marini, MD
Author and Funding Information

From the Pulmonary and Critical Care Section, Regions Hospital and the University of Minnesota.

Correspondence to: John J. Marini, MD, Regions Hospital, Pulmonary and Critical Care Medicine, MS 11203B, 640 Jackson St, St. Paul, MN 55101-2595; e-mail: john.j.marini@healthpartners.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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):286-290. doi:10.1378/chest.11-1060
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Extract

Pressure assist-control ventilation (PACV) is a form of time-cycled ventilatory support in which a nearly constant pressure is applied to the airways opening, independently of changing respiratory impedance or patient effort (Fig 1). Enthusiasm for this mode has grown steadily over the past 2 decades, due in part to its properties of limiting maximal airways pressure while offering virtually unrestricted flow. For many, PACV has become an entrenched component of “lung-protective” ventilation. At the outset of this intentionally polarized discussion, it is important to understand that no mode of mechanical ventilation is inherently safer than another, as all can be provided safely or not, depending on the settings that the clinician selects, the alarms that place limits on the process, and the vigilance with which the caregiver makes appropriate adjustments in response to the changing nature of the problem.

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