Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position

Abstract Background：In traditional Volume-Controlled Ventilation (VCV) mode, the creation of pneumoperitoneum during laparoscopic surgery may lead to Ventilator-Associated Lung Injury (VALI). Pressure-Controlled Ventilation with Volume Guarantee (PCV-VG) mode ensures providing adequate oxygen supply to patients while reducing the risk of lung injury. Methods：Eligible randomized clinical trials (RCTs) were searched in Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Sino Med, China National Knowledge Infrastructure (CNKI) and Wan-Fang MED without language restriction up to March 2019. The primary outcome of this meta-analysis was airway peak pressure (Ppeak) at 30, 60 or 90 mins after complete CO2 insufflation. This meta-analysis was followed the recommendations of the PRISMA statement. Results：Finally, 9 articles were included. The Ppeak in the PCV-VG group was lower than that in the VCV group, and the difference was statistically significant at 30mins [Mean Difference (MD)= -3.55, 95% Confidence Interval (CI)= -5.13 to -1.98, I2=83%], 60mins [MD= -5.76, 95%CI= -8.15-3.36, I2=93%], 90 mins [MD= -4.59, 95%CI= -5.43-3.74, I2=30%] after complete CO2 insufflation. Meanwhile, PCV-VG mode could effectively reduce airway mean pressure (Pmean) and improve dynamic compliance (Cdyn) of patients after complete CO2 insufflation in laparoscopic surgery compared to VCV mode. However, no significant difference was found in PetCO2, HR, MAP, PH, PaO2, and PaCO2 between the two-ventilation modes. Conclusions: PCV-VG mode are superior to VCV mode in providing adequate oxygenation at lower airway peak pressure and greater dynamic compliance in patients under laparoscopic surgery.

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Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10061276 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1276

Author(s):

Volker Schick ◽

Fabian Dusse ◽

Ronny Eckardt ◽

Steffen Kerkhoff ◽

Simone Commotio ◽

...

Keyword(s):

Systematic Review ◽

Elective Surgery ◽

Meta Analysis ◽

Lung Ventilation ◽

One Lung Ventilation ◽

Controlled Ventilation ◽

Pressure Controlled Ventilation ◽

Volume Controlled Ventilation ◽

Volume Controlled ◽

Pressure Controlled

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

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