Impact of the modality of mechanical ventilation on bleeding during pituitary surgery: A single blinded randomized trial

Morgan Le Guen, Alexis Paternot, Agnes Declerck, Elodie Feliot, Etienne Gayat, Stephan Gaillard, Marc Fischler, Morgan Le Guen, Alexis Paternot, Agnes Declerck, Elodie Feliot, Etienne Gayat, Stephan Gaillard, Marc Fischler

Abstract

Background: Bleeding modifies the surgeon's view of the field during transsphenoidal endoscopic pituitary surgery. Since ventilation can alter venous return, we compared the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on intraoperative bleeding.

Methods: Eighty-six patients were randomized to VCV or PCV in this single blinded study; comparisons concerned 42 in the PCV group and 43 in the VCV group.

Results: Intraoperative bleeding, the primary endpoint, did not differ between groups whether analysis focused on 7 levels of the score, from minimal bleeding to bleeding with significant change in the conduct of surgical procedure (P = .89) or on a stratification into 3 categories, mild, moderate, and major (P = .47). Median [interquartile range] peak airway pressure was lower in the PCV group (13.5 [12.5-15] vs 16.3 [14.4-19.1] cm H2O, P < .001) while mean airway pressures were similar (P = .08). Means ± SD of tidal volumes were lower in the VCV group when expressed as absolute values (470.6 ± 84 vs 434.7 ± 71.7 ml, P = .05) or as tidal volume/theoretical ideal weight ratio (6.7 [6.5-7] vs 7.2 [6.9-7.9], P < .001). The 2 groups were similar for postoperative complications and number of patients cured.

Conclusion: In conclusion, ventilation mode does not influence intraoperative bleeding during transsphenoidal pituitary surgery.

Trial registration: Clinicaltrials.gov identifier: NCT01891838; July 3, 2013.

Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Consort flow. PCV = pressure-controlled ventilation, VCV = volume-controlled ventilation.
Figure 2
Figure 2
Intensity of intraoperative bleeding depending on the ventilation mode. In abscissa, the scale of bleeding. A: 7 levels from 1 (minimal bleeding) to 7 (heavy bleeding leading to a change in the surgery). B: 3 categories: category 1 (levels 1 + 2 + 3), category 2 (levels 4 + 5), category 3 (levels 6 + 7). P values and proportional cumulative OR (Odds ratio [95% Confidence Interval]) for the differences between the levels of bleeding.

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