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Comparative evaluation of the cardiorespiratory effects of assist control ventilation vs pressure support ventilation in patients following orthotopic liver transplantation.

OBJECTIVE
1) To compare the haemodynamic tolerance of ACV and PSV in patients mechanically ventilated after orthotopic liver transplantation; 2) to compare patients comfort during ACV and PSV.


DESIGN
Prospective randomized cross-over study.


SETTING
General ICU of the University of Rome "La Sapienza".


PATIENTS
Eighteen patients admitted in ICU after orthotopic liver transplantation.


MEASUREMENT AND RESULTS
Haemodynamic, oxygen transport and blood gas data were compared during an ACV and PSV trial (30'). A statistically significant decrease of mean pulmonary and systemic arterial pressure, PCOP, LVSWI, occurred during the PSV trial. PaO2 and DO2I decreased during PSV, but were still in supranormal range; 16 out of 18 patients described PSV as more comfortable.


CONCLUSIONS
ACV and PSV provided a comparable haemodynamic tolerance in our patients, although during PSV the PaO2 was slightly decreased, probably due to decreased mean airway pressure (from 9.3 +/- 1.2 cmH2O during ACV to 6.6 +/- 1 cmH2O during PSV). PSV can be considered as a good alternative to the standard weaning techniques following orthotopic liver transplantation.