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Mechanical Ventilation: Pressure-Regulated Volume Control Ventilation (Respiratory Therapy)

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JUL.27.2023
S H A R E T H I S PA G E

MECHANICAL VENTILATION: PRESSURE-REGULATED VOLUME CONTROL

VENTILATION (RESPIRATORY THERAPY)

ALERT
Ventilator failure or accidental disconnection can be catastrophic in patients undergoing neuromuscular
blockade.

OVERVIEW
Pressure-regulated volume control (PRVC) ventilation is designed for invasive mechanical ventilation and
combines volume and pressure strategies. PRVC delivers a pressure-controlled and tidal volume (VT)–targeted
breath using a decelerating flow waveform pattern that allows unrestricted spontaneous breathing with or
without pressure support (PS). Setting options, terminology, and abbreviations may be brand specific based on
the mechanical ventilator specifications.undefined#ref2">2

PRVC is considered an advanced dual-control or adaptive mode because the ventilator uses both volume and
pressure to automatically adjust to the patient’s ventilatory needs breath by breath. [1] Pressure, flow, or volume
delivery depends on variables such as lung compliance, airway resistance, and respiratory effort. [4] The
mechanical ventilator delivers the lowest pressure and appropriate flow to meet the set VT target for each
delivered breath. [1], [3] A mandatory rate is set for the patient. The patient may breathe above the set rate. All

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 (ARDS) management goals by maximizing alveolar recruitment, patient comfort, and patient-ventilator
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synchrony, while minimizing the risk of barotrauma or volutrauma. [1], [4] PRVC can automatically adjust to
changes in lung compliance and airway resistance on a breath-by-breath basis. If the patient’s lung compliance
decreases or airway resistance increases, the system flow and pressure increase. If lung compliance increases or
airway resistance decreases, the system flow and pressure decrease. PRVC provides the comfort and safety of
pressure ventilation for patients of all ages with a set target for VT and minute ventilation.

SUPPLIES
See Supplies tab at the top of the page.

EDUCATION
Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to
learn, and overall neurologic and psychosocial state.
Explain the need for ventilator changes to the patient and family.
Encourage questions and answer them as they arise.

ASSESSMENT AND PREPARATION

ASSESSMENT
Perform hand hygiene before patient contact. Don appropriate personal protective equipment (PPE) based on
the patient’s need for isolation precautions or the risk of exposure to bodily fluids.
Introduce yourself to the patient.
Verify the correct patient using two identifiers.
Assess the patient’s level of consciousness and ability to understand and participate in decisions. Include the
patient as much as possible in all decisions.
Assess the patient for PRVC or equivalent mode and signs of ARDS. [2]
Decreasing partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio
Increasing plateau pressure, peak inspiratory pressure (PIP), or mean airway pressure (MAP)
Bilateral lung infiltrates on a chest radiograph
Assess the patient’s hemodynamic and cardiorespiratory systems.

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 PROCEDURE
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Perform hand hygiene and don gloves. Don additional PPE based on the patient’s need for isolation
precautions or the risk of exposure to bodily fluids.
Verify the correct patient using two identifiers.
Explain the procedure and ensure that the patient agrees to treatment.
Transition the patient to PRVC or an equivalent mode using the prescribed settings.

Setting options, terminology, and abbreviations may be brand specific based on trademarked mechanical
ventilator specifications.

Select the appropriate patient designation (e.g., adult, pediatric, infant).

Select and enter the PRVC or equivalent mode depending on the manufacturer’s software.
Set the desired minimum respiratory rate.

The patient may breathe above the set respiratory rate.

Set the desired VT target using ideal body weight calculations for lung protective strategy.

If the VT target is not met, the ventilator responds by adjusting the inspiratory pressure up or down
accordingly in small increments in the attempt to meet the VT target for the next breath (Figure 1).

Set the desired FIO2 delivery.

Set the desired inspiratory time or inspiratory-to-expiratory (I:E) ratio.
Set the desired PEEP level.
Set the desired trigger sensitivity (pressure or flow).
Set the desired PS, if applicable.
Set the upper pressure limit.

Consider 35 cm H2O as the initial setting and lung protective strategy because the ventilator should not allow
the pressure to rise higher than 5 cm H2O below the upper pressure limit setting and will signal an alarm. [1]

Ensure that all ventilator alarms are on and set appropriately for the patient’s individual ventilator settings.
Remove PPE and perform hand hygiene.
Document the procedure in the patient’s record.

MONITORING AND CARE

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 o e al eola de ec u t e t, co s de us g a closed suct o de ce to e t e u be o t es
the patient is disconnected from the ventilator.
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Maintain the humidification device and circuit temperature (if applicable) to avoid excessive condensation in
the ventilator circuit.
Observe the patient for signs and symptoms of pain. If pain is suspected, report it to the authorized
practitioner.

EXPECTED OUTCOMES
Improved oxygenation
Improved ventilation
Improved patient-ventilator synchrony and comfort
Minimized ventilator-induced lung injury
Liberation from mechanical ventilation

UNEXPECTED OUTCOMES
Alveolar overdistention
Increased work of breathing
Worsening oxygenation
Worsening ventilation
Ventilator-associated event
Hemodynamic compromise

DOCUMENTATION
Set target VT
Set respiratory rate
Set FIO2
Set inspiratory time or I:E ratio
Set PEEP level
Set trigger sensitivity
Set PS, if applicable

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 Patient’s tolerance of appearance
Education
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Unexpected outcomes and related interventions

REFERENCES
[1] Cairo, J.M. (Ed.). (2020). Chapter 5: Selecting the ventilator and the mode. In Pilbeam’s mechanical
ventilation: Physiological and clinical applications (7th ed., pp. 58-79). St. Louis: Elsevier.

[2] Hess, D.R., Kacmarek, R.M. (Eds.). (2019). Chapter 8: Advanced modes of mechanical ventilation. In
Essentials of mechanical ventilation (4th ed., pp. 73-86). New York: McGraw-Hill Education.

[3] Holt, G.A., Habib, S.A., Shelledy, D.C. (2020). Chapter 3: Principles of mechanical ventilation. In D.C.
Shelledy, J.I. Peters (Eds.), Mechanical ventilation (3rd ed., pp. 95-154). Burlington, MA: Jones & Bartlett
Learning.

[4] Shelledy, D.C., Peters, J.I. (2020). Chapter 6: Ventilator initiation. In D.C. Shelledy, J.I. Peters (Eds.),
Mechanical ventilation (3rd ed., pp. 311-366). Burlington, MA: Jones & Bartlett Learning.

ADDITIONAL READINGS
Matusov, Y. and others. (2020). Use of pressure-regulated volume control in the first 48 hours of hospitalization of
mechanically ventilated patients with sepsis or septic shock, with or without ARDS. Journal of the Intensive Care
Society, 21(4), 305-311. doi:10.1177/1751143719878969

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