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Monitoring during mechanical ventilation: MECHANICS DURING MECHANICAL VENTILATION (2)

Point-of-care testing

During pressure ventilation, PIP and Pplat may be equal. This is due to the flow waveform that occurs during this mode of ventilation. With pressure ventilation, flow decreases during inspiration and is often followed by a period of zero-flow at end-inspiration. During this period of no flow, proximal airway pressure should be equal to peak alveolar pressure. It follows that PIP should be lower during pressure ventilation than during volume ventilation. With volume ventilation, PIP is greater than Pplat due to the presence of end-inspiratory flow. With pressure ventilation, PIP equals Pplat if end-inspiratory flow is zero. With all other factors held constant (eg, VT, lung impedance, PEEP), Pplat is identical for volume and pressure ventilation. Because lung injury is related primarily to peak alveolar pressure (ie, Pplat), the importance of the decrease in PIP that occurs when changing from volume to pressure ventilation is questionable. It is now commonly accepted that Pplat should ideally be maintained below 35 cm H2O in patients with normal chest wall compliance (ie, transpulmonary pressure less than 30 cm H2O). You will love this opportunity to shop with best pharmacy on the internet and pay less every time you visit: buy levitra professional online click here to discover exactly how much less you could be spending while still getting your treatment exactly the way you need it.

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