Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Kyu Nam Kim, Dong Won Kim, Mi Ae Jeong, Yeong Hun Sin, Soo Kyung Lee, Kyu Nam Kim, Dong Won Kim, Mi Ae Jeong, Yeong Hun Sin, Soo Kyung Lee

Abstract

Background: Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively.

Methods: We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. A meta-analysis of randomized controlled trials was performed using the Cochrane Review Methods.

Results: Six studies (259 participants) were included. The PaO2/FiO2 ratio in PCV was higher than in VCV [weighted mean difference (WMD) = 11.04 mmHg, 95 % confidence interval (CI) = 0.30 to 21.77, P = 0.04, I(2) = 3 %] and peak inspiratory pressure was significantly lower in PCV (WMD = -4.91 cm H2O, 95 % CI = -7.30 to -2.53, P < 0.0001, I (2) = 91 %). No differences in PaCO2, tidal volume, heart rate and blood pressure were observed. There were also no differences incompliance, plateau and mean airway pressure.

Conclusions: Our meta-analysis provided the evidence of improved oxygenation in PCV. However, it is difficult to draw any definitive conclusions due to the fact that the duration of ventilation in the studies reviewed was insufficient to reveal clinically relevant benefits or disadvantages of PCV. Significantly lower peak inspiratory pressure is the advantage of PCV.

Keywords: One-Lung Ventilation; Respiration, artificial.

Figures

Fig. 1
Fig. 1
Flow-chart of the literature search strategy
Fig. 2
Fig. 2
a Risk-of-bias graph of all the included randomized controlled trials. b Risk-of-bias summary of all the included randomized controlled trials
Fig. 3
Fig. 3
Meta-analysis of the effect of intraoperative ventilation with pressure-controlled ventilation compared with volume-controlled ventilation. a Impact on PaO2/FiO2 ratio (mmHg). b Impact on PaCO2 (mmHg)
Fig. 4
Fig. 4
Meta-analysis of the effect of intraoperative ventilation with pressure-controlled ventilation compared to volume-controlled ventilation. a Impact on peak airway pressure (cmH2O). b Impact on plateau airway pressure (cmH2O). c Impact on mean airway pressure (cmH2O). d Impact on compliance (ml/cmH2O)
Fig. 5
Fig. 5
Subgroup analysis during pressure-controlled ventilation compared to volume-controlled ventilation. a The effect of paravertebral block on PaO2/FiO2 ratio (mmHg). b The effect of paravertebral block on PaCO2 (mmHg). c The effect of tidal volume (6–8 ml/kg vs 9–10 ml/kg) on PaO2/FiO2 ratio

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