The Effect of Volume Controlled and Pressure Controlled Ventilation Modes on Cerebral Oximetry and Blood Gas Status in Laparoscopic Cholecystectomy, A Randomized Controlled Trial

Background: To compare the volume-controlled and pressure-controlled ventilation modes with near infrared spectroscopy (NIRS) cerebral oximetry and blood gas status in laparoscopic cholecystectomyMethods: Seventy patients (n=70), who underwent elective laparoscopic cholecystectomy operation were randomized into two groups (volume control ventilation - group V, pressure control ventilation - group P). Demographic data (age, gender, body mass index) and operative data (anesthesia, surgery, and insufflation durations) were recorded. Patients’ single derivation electrocardiogram, pulse oximetry, non-invasive arterial pressure, NIRS cerebral oximetry and end-tidal CO2 parameters were recorded. Measurements were done at the start of anesthesia (T0), at the end of intubation (T1), 5 minutes after the insufflation (T2), at the time just before desufflation (T3) and 5 minutes after desufflation (T4).The patients’ heart rate, systolic and diastolic arterial pressure, saturation of pulse oximetry, and NIRS values were recorded for time points. Additionally, arterial gas results and mechanical ventilation parameters were recorded as well. Results: No significant difference was found in age, sex, body mass index. Operation, anesthesia and insufflation durations were similar for the groups. In Group P, NIRS right T1-2-3 averages and NIRS left T2-3 averages were significantly higher than Group V (p=0.030, p=0.001, p=0.001, p=0.006, p=0.002 respectively). In Group P T1-T2-T4, mean peak pressures and mean plateau pressures were significantly lower than Group V (p=0.003, p=0.001, p<0.001, p=0.011, p=0.001, p<0.001 respectively).Conclusion: Mechanical ventilation that performed in pressure-control ventilation mode is resulted with better tissue oxygenation than volume-control ventilation mode. In pressure-control ventilation mode, peak pressure and plateau pressure were lower.Registration of study at ClinicalTrials.gov was made at 25/01/2021 with the NCT04723043 number.

Crisis Ventilator: A 3D Printed Option for Pressure Controlled Ventilation

During the Coronavirus-19, or COVID-19, pandemic there was an early shortage of available ventilators. Domestic production was limited by dependence on overseas sources of raw materials despite partnering with automotive manufacturers. Our group has developed a 3D printed alternative called the CRISIS ventilator. Its design is similar to existing resuscitator devices on the market and uses a modified Pressure-Control ventilation. Here we compare the performance of the device on a simulated ARDS lung and handling of different clinical scenarios included tension pneumothorax and bronchospasm.

Minute ventilation stabilization during all pressure-control / support mechanical ventilation modes

The main goal of our prospective randomized study was comparing compare the effectiveness of ventilation control method „Automatic proportional minute ventilation (APMV) “versus manually set pressure control ventilation modes in relationship to lung mechanics and gas exchange. 80 patients undergoing coronary artery bypass grafting (CABG) were randomized into 2 groups. 40 patients in the first group No. 1 (APMV group) were ventilated with pressure control (PCV) or pressure support ventilation (PSV) mode with APMV control. The other 40 patients (control group No.2) were ventilated with synchronized intermittent mandatory ventilation (SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control with APMV was able to maintain minute ventilation more precisely in comparison with manual control (p<0.01), similarly deviations of ETCO2 were significantly lower (p<0.01). The number of manual corrections of ventilation settings was significantly lower when APMV was used (p<0.01). The differences in lung mechanics and hemodynamics were not statistically significant. Ventilation using APMV is more precise in maintaining minute ventilation and gas exchange compared with manual settings. It required less staff intervention, while respiratory system mechanics and hemodynamics are comparable. APMV showed as effective and safe method applicable on top of all pressure control ventilation modes.

Plateau Pressure during Pressure Control Ventilation

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