Ventilatory management of pulmonary contusion patients

BACKGROUND: The goal of this study was to evaluate two modes of mechanical ventilation in patients with pulmonary contusion: pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV). METHODS: One hundred and thirty-five patients with pulmonary contusion, defined as an infiltrate on admission chest x-ray and hypoxemia, were treated over 45 months; 59 patients who required more than 48 hours of mechanical ventilation were initially managed with VCV. RESULTS: Twenty patients were converted from VCV to PCV when pulmonary function deteriorated. With PCV, peak inspiratory pressure decreased from 49 ± 1 to 31 ± 1 cm H₂O, the alveolar-arterial oxygen difference decreased from 491 ± 36 mm Hg to 300 ± 36 mm Hg. These findings were significantly different (P < 0.05, by Student's paired t- test). Twenty patients managed with PCV had equivalent duration of mechanical ventilation and days in intensive care units to 39 patients with less pulmonary dysfunction managed with VCV. None of the 10 patients who died expired from pulmonary failure. CONCLUSIONS: PCV is an alternative mode to VCV in patients with poorly compliant lungs after pulmonary contusion.