Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial

Hakan Yılmaz, Baturay Kansu Kazbek, Ülkü Ceren Köksoy, Ahmet Murat Gül, Perihan Ekmekçi, Gamze Sinem Çağlar, Filiz Tüzüner, Hakan Yılmaz, Baturay Kansu Kazbek, Ülkü Ceren Köksoy, Ahmet Murat Gül, Perihan Ekmekçi, Gamze Sinem Çağlar, Filiz Tüzüner

Abstract

Purpose: To compare hemodynamic effects of two different modes of ventilation (volume-controlled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic gynecology surgeries with exaggerated Trendelenburg position.

Methods: Thirty patients undergoing laparoscopic gynecology operations were ventilated using either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording Analytical Method by radial artery cannulation in addition to peak and mean airway pressures and expired tidal volume.

Results: The only remarkable finding was a more stable cardiac index in Group PCVG, where other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while peak airway pressure was lower in Group PCVG.

Conclusion: PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated Trendelenburg position in laparoscopic surgery.

Keywords: Hemodynamic monitoring; Laparoscopic surgery; Mechanical ventilation.

Copyright © 2021. Published by Elsevier Editora Ltda.

Figures

Fig. 1
Fig. 1
Cardiac index variations measured by Pressure Recording Analytical Method in both groups. Data (means ± SD) are the same as those shown in Table 2. Ti, anesthesia induction; T0, peritoneal insufflation; T1, T3, T5, T10, and T30,1, 3, 5, 10, and 30 minutes after CO2 pneumoperitoneum respectively; Tdef, desufflation; T5def, termination of pneumoperitoneum (5 minutes after desufflation). PCVG, Pressure-Controlled Volume-Guaranteed ventilation; VCV, Volume-Controlled Ventilation. Figure 1 indicates that there is more variation in group VC compared to group PCVG (p = 0.025).
Fig. 2
Fig. 2
Peak inspiratory pressures at different time points in both groups. Boxplot graphic, middle line of box; median value, upper-lower line of box; 25–75%, upper-lower line of whisker; min-max value excluding outliers. Ti, anesthesia induction; T0, peritoneal insufflation; T1, T3, T5, T10, and T30, 1, 3, 5, 10, and 30 minutes after CO2 pneumoperitoneum, respectively; Tdef, desufflation; T5def, termination of pneumoperitoneum (5 minutes after desufflation). PCVG, Pressure-Controlled Volume-Guaranteed ventilation; VCV, Volume-Controlled Ventilation.
Fig. 3
Fig. 3
Expiratory tidal volumes at different time points in both groups. Boxplot graphic, middle line of box; median value, upper-lower line of box; 25–75% percentile, upper-lower line of whisker; min-max value excluding outliers. Ti, anesthesia induction; T0, peritoneal insufflation; T1, T3, T5, T10, and T30, 1, 3, 5, 10, and 30 minutes after CO2 pneumoperitoneum, respectively; Tdef, desufflation; T5def, termination of pneumoperitoneum (5 minutes after desufflation). PCVG, Pressure-Controlled Volume-Guaranteed ventilation; VCV, Volume-Controlled Ventilation.

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Source: PubMed

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