Comparison of volume-controlled ventilation mode and pressure-controlled ventilation with volume-guaranteed mode in the prone position during lumbar spine surgery

Jung Min Lee, Soo Kyung Lee, Kyung Mi Kim, You Jung Kim, Eun Young Park, Jung Min Lee, Soo Kyung Lee, Kyung Mi Kim, You Jung Kim, Eun Young Park

Abstract

Background: During lumbar spine surgery, patients are placed in the prone position for surgical access. The prone position has various effects on cardiac and pulmonary function, including a decreased cardiac index (CI), decreased dynamic lung compliance (Cdyn), and increased peak inspiratory pressure (Ppeak). In this study, we compared the volume-controlled ventilation mode (VCV) and pressure-controlled ventilation with volume guaranteed mode (PCV-VG) based on hemodynamic and pulmonary variables in the prone position during lumbar spine surgery.

Methods: Thirty-six patients scheduled for lumbar spine surgery in the prone position were enrolled in this prospective, randomized clinical trial. The patients were randomly assigned to receive VCV or PCV-VG. Hemodynamic variables, respiratory variables, and arterial blood gases were measured in the supine position 15 min after the induction of anesthesia, 15 min after placement in the prone position, 30 min after placement in the prone position, and 15 min after placement in the supine position at the end of anesthesia.

Results: The hemodynamic variables and arterial blood gas results did not differ significantly between the two groups. Lower Ppeak values were observed in the PCV-VG group than in the VCV group (p = 0.045). The Cdyn values in the VCV group were lower than those in the PCV-VG group (p = 0.040).

Conclusion: PCV-VG led to lower Ppeak and improved Cdyn values compared with VCV, showing that it may be a favorable alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery.

Trial registration: The study was retrospectively registered at ClinicalTrials.gov (NCT03571854). The initial registration date was 6/18/2018.

Keywords: Cardiac output; General anesthesia; Mechanical ventilation; Spine surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The CONSORT flow diagram
Fig. 2
Fig. 2
Peak airway pressure at each measurement timepoint in each group Data are displayed as ranges, medians, and interquartile ranges. VCV, volume controlled ventilation; PCV-VG, pressure-controlled ventilation with volume guaranteed mode. *p < 0.05 compared with the VCV group at the same time point
Fig. 3
Fig. 3
Dynamic lung compliance at each measurement timepoint in each group. Data are displayed as ranges, medians, and interquartile ranges. VCV, volume-controlled ventilation, PCV-VG, pressure-controlled ventilation with volume guaranteed. *p < 0.05 compared with the VCV group at the same time point

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