Pressure-controlled Ventilation Does Not Improve Gas Exchange in Morbidly Obese Patients Undergoing Abdominal Surgery

Abstract Background Although numerous studies conducted in the past years, there is no superior guideline that indicates the best ventilation mode during laparoscopic anesthesia inobese patients. There are numerous studies with dissimilar controversial points. The management of oxygenation in a morbid obese patient undergoing laparoscopic procedures presents many challenging aspects to the anesthetist. Objective The aim of this study was to equate the effect of pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on respiratory, oxygenation parameters and post operative complications. Patients and Methods This study was conducted on 80 patients who underwent laparoscopic gastric sleeve surgery in Ain Shams University Hospitals. Post induction of Anesthesia, Patients were divided into two groups. The first group mechanical ventilation setting was volume controlled ventilation and the second group mechanical ventilation setting was pressure controlled ventilation. Results The results of our study shows that despite some valuable effects regarding plateau and mean airway pressure with PCV, there is no momentous clinical difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) in obese patients undergoing laparoscopic gastric sleeve surgery. However, pressure controlled ventilation shows slightly more favorable results regarding post extubation oxygen saturation and the decrease of post operative basal atelectasis. It appears that using dual modes would be an epitome approach with lower complications and similar outcomes.

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Effects on Lung Gas Volume, Respiratory Mechanics and Gas Exchange of a Closed-Circuit Suctioning System during Volume- and Pressure-Controlled Ventilation in ARDS Patients

Journal of Clinical Medicine ◽

10.3390/jcm10235657 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5657

Author(s):

Davide Chiumello ◽

Luca Bolgiaghi ◽

Paolo Formenti ◽

Tommaso Pozzi ◽

Manuela Lucenteforte ◽

...

Keyword(s):

Gas Exchange ◽

Respiratory Mechanics ◽

Pressure Control ◽

Closed Circuit ◽

Volume Control ◽

Endotracheal Suctioning ◽

Controlled Ventilation ◽

Pressure Controlled Ventilation ◽

Gas Volume ◽

Pressure Controlled

Mechanically ventilated patients periodically require endotracheal suctioning. There are conflicting data regarding the loss of lung gas volume caused by the application of a negative pressure by closed-circuit suctioning. The aim of this study was to evaluate the effects of suctioning performed by a closed-circuit system in ARDS patients during volume- or pressure-controlled ventilation. In this prospective crossover-design study, 18 ARDS patients were ventilated under volume and pressure control applied in random order. Gas exchange, respiratory mechanics and EIT-derived end-expiratory lung volume (EELV) before the suctioning manoeuvre and after 5, 15 and 30 min were recorded. The tidal volume and respiratory rate were similar in both ventilation modes; in volume control, the EELV decreased by 31 ± 23 mL, 5 min after the suctioning, but it remained similar after 15 and 30 min; the oxygenation, PaCO2 and respiratory system elastance did not change. In the pressure control, 5 min after suctioning, EELV decreased by 35 (26–46) mL, the PaO2/FiO2 did not change, while PaCO2 increased by 5 and 30 min after suctioning (45 (40–51) vs. 48 (43–52) and 47 (42–54) mmHg, respectively). Our results suggest minimal clinical advantages when a closed system is used in volume-controlled compared to pressure-controlled ventilation.

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