Comparisons of Pressure-controlled Ventilation with Volume Guarantee and Volume-controlled 1:1 Equal Ratio Ventilation on Oxygenation and Respiratory Mechanics during Robot-assisted Laparoscopic Radical Prostatectomy: a Randomized-controlled Trial

Min-Soo Kim, Sarah Soh, So Yeon Kim, Min Sup Song, Jin Ha Park, Min-Soo Kim, Sarah Soh, So Yeon Kim, Min Sup Song, Jin Ha Park

Abstract

Background: During robot-assisted laparoscopic radical prostatectomy (RALP), steep Trendelenburg position and carbon dioxide pneumoperitoneum are inevitable for surgical exposure, both of which can impair cardiopulmonary function. This study was aimed to compare the effects of pressure-controlled ventilation with volume guarantee (PCV with VG) and 1:1 equal ratio ventilation (ERV) on oxygenation, respiratory mechanics and hemodynamics during RALP. Methods: Eighty patients scheduled for RALP were randomly allocated to either the PCV with VG or ERV group. After anesthesia induction, volume-controlled ventilation (VCV) was applied with an inspiratory to expiratory (I/E) ratio of 1:2. Immediately after pneumoperitoneum and Trendelenburg positioning, VCV with I/E ratio of 1:1 (ERV group) or PCV with VG using Autoflow mode (PCV with VG group) was initiated. At the end of Trendelenburg position, VCV with I/E ratio of 1:2 was resumed. Analysis of arterial blood gases, respiratory mechanics, and hemodynamics were compared between groups at four times: 10 min after anesthesia induction (T1), 30 and 60 min after pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after desufflation and resuming the supine position (T4). Results: There were no significant differences in arterial blood gas analyses including arterial oxygen tension (PaO2) between groups throughout the study period. Mean airway pressure (Pmean) were significantly higher in the ERV group than in the PCV with VG group T2 (p<0.001) and T3 (p=0.002). Peak airway pressure and hemodynamic data were comparable in both groups. Conclusion: PCV with VG was an acceptable alternative to ERV during RALP producing similar PaO2 values. The lower Pmean with PCV with VG suggests that it may be preferable in patients with reduced cardiovascular function.

Keywords: arterial oxygenation; autoflow; equal ratio ventilation; pressure-controlled ventilation with volume guarantee; respiratory mechanics; robot-assisted laparoscopic radical prostatectomy; volume-controlled ventilation.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Patient enrolment into the study (using CONSORT recommendations). PCV with VG, pressure-controlled ventilation with volume guarantee; ERV, equal ratio ventilation.
Figure 2
Figure 2
Perioperative hemodynamic variables. Values are mean ± standard deviation. PCV with VG, pressure-controlled ventilation with volume guarantee; ERV, equal ratio ventilation; MAP, mean arterial pressure. T1, 10 min after anesthesia induction under supine position; T2, 30 min after initiation of carbon dioxide (CO2) pneumoperitoneum and Trendelenburg position; T3, 60 min after initiation of CO2 pneumoperitoneum and Trendelenburg position; T4, 10 min after CO2 desufflation and resuming the supine position.

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