Hello? It's been a while, but can I answer you? I am an anesthesiologist in South Korea. I think pressure mode is more suitable. The reason is that the pressure control mode can prevent alveolar hyperinflation and lung demage by controlling inspiratory pressure.

Pressure mode

Farouk Kamal It depends...

A specific mode is rarely "the mode" for the patient. Oftentimes, patients with ILD (which covers a spectrum of pulmonary disorders, so I will focus on the primary pathophysiology) have very fast time constants (think quick to fill/quick to empty) with restrictive pulmonary physiology. Volume-control modes of ventilation have a constant flow rate, pressure controlled modes do not; the rate is variable and dictated by the patient. At this point in mechanical ventilator technology, both may be delivered with a decelerating waveform That said, a pressure-controlled mode of ventilation may meet the inspiratory flow demands of the patient, but the pressure required to inflate the lungs (in terms of Pplat) will be potentially similar to that of a volume control for the same tidal volume (if that is your primary concern). I think you are missing the big picture and should consider the independent ventilatory parameters.

For example, what do we know about "recruitability" of the fibrotic lung? It's pretty minimal, but FRC needs to be maintained. (see comment about time constants). "High PEEP" (≥ 10 cmH2O in this cohort), age, P/F ratio, and disease severity are associated with decreased survival in subjects with ILD (Fernandez-Perez, 2008)....just as a quick example. Keep in mind, as with any ventilatory parameter/study related to critically ill patients, those (and I mean this very, very generally) receiving relatively high levels of mechanical ventilator support (i.e., PEEP) may in fact be acutely sicker, have a more significant number comorbidities, or perhaps have not been managed correctly during their clinical course yet an intervention was associated with a measured outcome. Furthermore, flow and respiratory rate are two other drivers of lung injury that should be considered in terms of the "big picture." I'm not going to touch on tidal volume as that topic has been covered thoroughly in the literature. I suggest you venture into the world of mechanical power and take in the theoretical application of the energy/physics associated with that concept.

Long story short, there is not a "mode" that is best for a specific patient but rather one that (a) protects the lungs (as reasonably as possible; (b) promotes machine/patient synchrony (if not wholly passive); (c) meets reasonable physiologic goals for the specific patient. This is why a well-informed practitioner is the best "mode" of mechanical ventilation, but I may be biased as a respiratory therapist.

I prefer pressure modes of ventilation. Unfortunately, the deciding factor will be the MD’s preference and what they are comfortable with.