Pressure Control Inverse Ratio Ventilation as a Method to Reduce Peak Inspiratory Pressure and Provide Adequate Ventilation and Oxygenation

Nineteen patients with ARDS or pneumonia who were ventilated with PcIRV on the Siemens-Elema Servo 900 C were retrospectively reviewed. The PcIRV reduced peak airway pressure, PEEP, increased P aw ¯ , and improved ventilation and oxygenation in these patients. When these patients were compared with themselves on prior conventional IPPV, all had a decrease in PIP, an increase in P aw ¯ and most had a decrease in V ˙ E , with no change in PaCO 2 and an increase in PaO 2 . The increase in P aw ¯ may have contributed to this improved arterial oxygenation. High levels of PIP and PEEP during IPPV have been identified as risk factors in the development of barotrauma and residual parenchymal pulmonary damage. We propose that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O 2 concentration. This mode of ventilation may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.