Controversies in the critical care setting. Should adaptive pressure control modes be utilized for virtually all patients receiving mechanical ventilation?

Traditional mechanical ventilation is provided with either a constant volume or constant pressure breath. In recent years, dual-control (adaptive pressure control) has been introduced in an attempt to combine the attributes of volume ventilation (constant tidal volume and minute ventilation) with the attributes of pressure ventilation (rapid, variable flow and reduced work of breathing). Adaptive pressure control is a pressure-controlled breath that utilizes closed-loop control of the pressure setting to maintain a minimum delivered tidal volume. Prior to the introduction of adaptive pressure control, no clinical studies were accomplished. Studies have shown that adaptive pressure control reduces peak inspiratory pressure, compared to volume control. When compared to traditional pressure-control ventilation, no differences have been identified. While adaptive pressure control can guarantee a minimum tidal volume, it cannot guarantee a constant tidal volume. One concern is that the ventilator cannot distinguish between improved pulmonary compliance and increased patient effort. Clinicians should be aware of the limitations of adaptive pressure control and understand when other breath delivery techniques are more suitable.