What is the role of conventional ventilation (CMV) in the prevention of pulmonary interstitial emphysema (PIE)?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Different modes of CMV do not appear to affect the risk of PIE. Goel at al showed that the rate of PIE was significantly less while delivering nasal continuous positive airway pressure (CPAP) in the mask group as compared to cannula group (4.9% vs 17.5%; RR: 0.28, 95% CI: 0.08-0.96; P = 0.03). [56]

Although data are limited on the benefit of volume-targeted ventilation strategies, some data appear to be promising regarding volume-targeted ventilation to prevent PIE. Stefanescu et al reported that rates of PIE were lower among infants treated with volume guarantee pressure support ventilation versus pressure-controlled ventilation (odds ratio: 0.6; 95% confidence limits: 0.4, 0.8). [57] However, McCallion et al found no significant difference in the rate of PIE either in a pooled analysis within subgroups or the overall pooled analysis of trials comparing volume-targeted versus pressure-limited ventilation in the neonate. [58]

Avoid the use of high peak inspiratory pressure (PIP). Carefully monitor the PIP (watch the manometer) during manual ventilation.


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