The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery

2017 ◽  
Vol 31 (5) ◽  
pp. 651-656 ◽  
Author(s):  
Lili Xu ◽  
Jianjun Shen ◽  
Min Yan
Keyword(s):  
Laparoscopic Surgery ◽  
Obese Patients ◽  
Inverse Ratio Ventilation ◽  
Lung Protection ◽  
Effect Of Pressure ◽  
Pressure Controlled

Effect of pressure-controlled inverse ratio ventilation on dead space during robot-assisted laparoscopic radical prostatectomy

2018 ◽  
Vol 35 (4) ◽  
pp. 307-314 ◽  
Author(s):  
Go Hirabayashi ◽  
Yukihiko Ogihara ◽  
Shoichi Tsukakoshi ◽  
Kiyoshi Daimatsu ◽  
Masaaki Inoue ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Dead Space ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
Inverse Ratio Ventilation ◽  
Effect Of Pressure ◽  
Pressure Controlled

scholarly journals Inverse Ratio Ventilation for Preventing Intra-Operative Hypercapnia in Children Undergoing Laparoscopic Surgery

2021 ◽  
Author(s):  
XD Han ◽  
Wangping Zhang ◽  
XH Qian
Keyword(s):  
Laparoscopic Surgery ◽  
Respiratory Acidosis ◽  
Carbon Dioxide Tension ◽  
Control Group ◽  
Inverse Ratio Ventilation ◽  
Group I ◽  
Registration Number ◽  
End Tidal ◽  
Pressure Controlled ◽  
Group 1

Abstract BackgroundHigh end-tidal carbon dioxide tension (PETCO2) and respiratory acidosis occurs frequently in patients undergoing laparoscopic surgery. The aim of this study is to be investigate the effect of pressure-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory ratio (I: E) of 2:1 on children undergoing laparoscopic surgery. MethodsEighty children undergoing elective laparoscopic surgery were allocated randomly to the IRV group (1: E=2:1) and the control group (I: E=1:2). Children received pressure-controlled ventilation with I: E ratio of 2:1 or 1:2. Hemodynamic parameters and respiratory mechanics were recorded. Side effects were also recorded. ResultsAt 30 min after CO2 pneumoperitoneum, tidal volume (Vt) and arterial partial pressure of oxygen (PaO2) were greater in the IRV group than the control group (100.6 ± 6.6 vs. 95.1±7.9 ml, 282.7 ± 45.6 vs.246.5 ± 40.1mmHg, respectively) (P < 0.01), but PaCO2 was lower than the control group (43.9 ± 5.45 vs. 46.7 ± 4.90 mmHg, P = 0.013). The incidence of intra-operative hypercapnia was lower in the IRV group (25% vs. 42.5%, P= 0.03). ConclusionIRV may reduce the incidence of intra-operative hypercapnia as well as increasing Vt and thus improving CO2 elimination in children undergoing laparoscopy. (Registration number: ChiCTR2000035589)

scholarly journals Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position

2021 ◽  
Author(s):  
Jianli Li ◽  
Saixian Ma ◽  
Xiujie Chang ◽  
Songxu Ju ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Injury ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Trial Registry ◽  
Positive End Expiratory Pressure ◽  
Clinical Trial Registry ◽  
Trendelenburg Position ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

AbstractThe study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury.Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928

A SYSTEM FOR OPTIMAL CONTROL OF PRESSURE CONTROLLED INVERSE RATIO VENTILATION

1989 ◽  
Vol 71 (Supplement) ◽  
pp. A462
Author(s):  
L. Peng ◽  
T. D. East ◽  
N. L. Pace
Keyword(s):  
Optimal Control ◽  
Inverse Ratio Ventilation ◽  
Pressure Controlled

Alternative Modes of Mechanical Ventilation

2018 ◽  
Vol 29 (4) ◽  
pp. 396-404
Author(s):  
John J. Gallagher
Keyword(s):  
Mechanical Ventilation ◽  
Closed Loop ◽  
Treatment Options ◽  
Ventilatory Support ◽  
Dual Control ◽  
Mechanical Ventilators ◽  
Lung Protection ◽  
Ventilation Modes ◽  
Volume Controlled ◽  
Pressure Controlled

Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes. Alternative modes of ventilation are tools for lung protection, alveolar recruitment, and ventilator liberation. Understanding the function and application of these alternative modes prior to implementation is essential and is most beneficial for the patient.

scholarly journals Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

2021 ◽  
Vol 10 (1) ◽  
pp. 44
Author(s):  
Kenro Chikazawa ◽  
Ken Imai ◽  
Takaki Ito ◽  
Azusa Kimura ◽  
Hiroyoshi Ko ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Weight Reduction ◽  
Obese Patients ◽  
Weight Reduction Program ◽  
Reduction Program

The effect of pressure controlled intermittent coronary sinus occlusion during reperfusion

1986 ◽  
pp. 339-344 ◽  
Author(s):  
L. Papp ◽  
Violetta Kékesi ◽  
B. Osváth ◽  
A. Juhász-Nagy ◽  
Z. Szabó
Keyword(s):  
Coronary Sinus ◽  
Effect Of Pressure ◽  
Pressure Controlled

scholarly journals Airway Closure during Surgical Pneumoperitoneum in Obese Patients

2019 ◽  
Vol 131 (1) ◽  
pp. 58-73 ◽  
Author(s):  
Domenico Luca Grieco ◽  
Gian Marco Anzellotti ◽  
Andrea Russo ◽  
Filippo Bongiovanni ◽  
Barbara Costantini ◽  
...  
Keyword(s):  
Lung Volume ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Control Group ◽  
Obese Patients ◽  
Airway Closure ◽  
Alveolar Pressure ◽  
Opening Pressure ◽  
Airway Opening ◽  
Pressure Controlled

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundAirway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.MethodsWithin the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.ResultsEleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H2O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H2O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H2O [15 to 19] vs. 27 cm H2O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.ConclusionsIn obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

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