Severe Head Injury Management: A Comparative Study of Pressure Controlled and Volume Controlled Ventilation

Résumé

Background: A Glasgow Coma Score (GCS) of 3-8 indicates a severe head injury. This is common after a motor vehicular accident, which is a leading cause of death in our society. It may also occur as a result of civil unrest, among other things. These patients may require ventilatory support, especially if their respiratory system is in danger of failing. Objectives: The aim of the study was to prospectively compare which ventilation variable within the same mode of mechanical ventilation is a better option in this group of patients. Methodology: This was a prospective study of twenty-nine (29) patients from February to September 2021, admitted to the Intensive Care Unit (ICU) of 44 Nigeria Army Reference Hospital, Kaduna, with severe head injury within the first 72 hours of admission comparing two variables of the same mode of mechanical ventilatory support. Results: Peak airway pressure (p<0.15) was found to be significantly higher during volume-controlled ventilation (VCV), while arterial oxygen tension (p<0.5) was found to be significantly higher during pressure-controlled ventilation (PCV). Peak airway pressure (Paw) decreased consistently during PCV, with a percentage reduction ranging from 5% to 27%, with a mean of 13.3%. It was also discovered that during PCV, there was an increase in arterial oxygen tension as well as an improvement in arterial oxygenation in all patients (100%) compared to 9 (64.3%) patients during VCV. Conclusion: We concluded that PCV is as effective as VCV, but it is a better option for improving patient oxygenation in severely brain-injured patients. Though, a better option for oxygenation; the difference is not statistically significant. Pressure-controlled ventilation variables should be used in the first 72 hours of mechanical ventilator support for patients with severe head injuries.