PRESSURE REGULATED

VOLUME CONTROL (PRVC)

Charles S. Williams RRT, AE-C

PRVC

 First introduced on the Servo 300 ventilator. Is now available

on the Servo-I ventilator.

 PRVC is defined as pressure controlled ventilation with a

volume target. (Volume-targeted pressure control).

 It is considered a form of Dual-Mode ventilation.

 PRVC combines the advantages of both volume-controlled

(VC) and pressure-controlled (PC) ventilation.

Intro
PRVC

 PRVC will attempt to deliver the desired set tidal volume using
the lowest possible pressure.

 Use clinically as you would “standard” Volume Control (VC)

 Similar modes on other ventilators include:

1. AutoFlow (Drager Evita),
2. Adaptive Support Ventilation (Hamilton Galileo)
3. Volume Ventilation Plus (Puritan Bennett 840)

Intro
Volume-Control Ventilation (VCV)

 Assist-Control Ventilation

 Set mandatory (min) rate

 Every breath delivered, either ventilator initiated (control)

or patient initiated (assist), are identical.

 Peak inspiratory pressure (PIP) will vary depending on

lung mechanics. (compliance and airway resistance)

Volume Control
Volume-Control Ventilation (VCV)
*Screenshots have been modified for illustration purposes

Shown here is standard Volume Control mode.

The set tidal volume is 500.
Volume Control
Volume-Control Ventilation (VCV)
*Screenshots have been modified for illustration purposes

In VC, flow remains constant during inspiration.

Flowrate is normally a set parameter in VC.
Volume Control
Volume-Control Ventilation (VCV)
*Screenshots have been modified for illustration purposes

Pressure will vary depending on lung compliance, airway resistance, etc.

Volume Control
PRVC
*Screenshots have been modified for illustration purposes

Inspiratory Hold

When switching to PRVC mode, the ventilator first delivers a volume “test”
breath along with an inspiratory “hold” maneuver.
This is also done anytime ventilation has been interrupted, (opening the vent
circuit, suctioning, etc.)

PRVC
PRVC
*Screenshots have been modified for illustration purposes

Pplat

The inspiratory hold maneuver determines the patient’s plateau pressure

(Pplat).
The measured Pplat is then used to deliver the patient’s very next breath.

PRVC
PRVC
*Screenshots have been modified for illustration purposes

The ventilator then measures the exhaled tidal volume and compares it to the
set tidal volume.
Also note that pressure is now constant (with a square pattern) and flow has
become variable (with a decelerating ramp pattern ). Just as in Pressure
Control mode.
PRVC
PRVC
*Screenshots have been modified for illustration purposes

+3

The ventilator then regulates the amount of pressure needed to obtain the
desired set tidal volume.
It will increase or decrease the amount of pressure on a “breath by breath”
basis. (+/-3 cmH20 per breath)

PRVC
PRVC
Test Breath

Measure
Tidal Volume

Compare to
More Less
set
Tidal Volume
Decrease Increase
Inspiratory Inspiratory
Equal Pressure
Pressure

Give same
Inspiratory Pressure

PRVC Flowchart
PRVC

Advantages:
 “Guarantees” delivery of desired tidal volume.

 Minimizes risks of barotrauma due to high peak

pressures.

 Decelerating flow pattern may provide better distribution

of ventilation and oxygenation.

 Can better meet patients inspiratory flow demands.

Advantages
PRVC

Disadvantages:
 The ventilator may potentially increase pressures to
dangerously high levels as it attempts to maintain the
desired tidal volume.

1) The maximum delivered pressure is limited to 5cmH2O

below the set High Pressure alarm limit.
2) High Pressure alarm limit should be set at 35-40 cmH20.

Disadvantages
PRVC

Disadvantages:
 Pressure delivered is dependant on the tidal volume
achieved from the previous breath.

 If the patient intermittently makes a significant inspiratory

effort, it can result in variable tidal volumes than can be
higher or lower than the setting.

Disadvantages
 PRVC
*Screenshots have been modified for illustration purposes

Volume
(500ml)

In this example, the first breath is a control breath with the patient making no
respiratory effort this time.
The desired tidal volume of 500 is delivered here.
PRVC
*Screenshots have been modified for illustration purposes

Volume
(500ml)

The second breath is triggered by the patient who made a significant

inspiratory effort.
Although, PIP has remained the same as the first breath, a higher tidal volume
results because of higher transpulmonary pressure.
 PRVC
*Screenshots have been modified for illustration purposes

Volume
(500ml)

The ventilator will then reduce the amount of pressure needed for the next
breath.
The patient doesn’t make any inspiratory effort with this breath, the result is a
tidal volume that is lower than the set tidal volume.
PRVC

Automode/Volume Support

 For patients that are making intermittent inspiratory

efforts, or breathing spontaneously, switching to
Automode may be better.
 In Automode, the ventilator will automatically switch
between PRVC and Volume Support mode.
 PRVC breaths when there is no patient effort, and VS
breaths with patient effort).
Automode
PRVC

Automode/Volume Support

 Volume Support (VS) mode works in the same way as

PRVC.
 VS automatically adjusts the level of pressure support
needed to achieve a targeted tidal volume, based on
the amount of inspiratory effort given by the patient.
 Volume Support is basically, Pressure Support that
guarantees a set tidal volume.
Volume Support
Sources:

 PRVC
Dr. Charles Gomersall, Dept of Anaesthesia & Intensive Care,
The Chinese University of Hong Kong,
Prince of Wales Hospital

 Golden Moments In Mechanical Ventilation

Maqet, INC.

 Servo-I: Modes of Ventilation, Pocket Guide

Maqet, INC.

 Evidence Base for Newer Modes of Mechanical Ventilation

Charles B. Spearman, MSEd, RRT, FAARC
Assistant Professor
Respiratory Care Programs
Department of Cardiopulmonary Sciences
Loma Linda University