Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation

Seok Young Song, Jin Yong Jung, Min-Su Cho, Jong Hae Kim, Tae Ha Ryu, Bong Il Kim, Seok Young Song, Jin Yong Jung, Min-Su Cho, Jong Hae Kim, Tae Ha Ryu, Bong Il Kim

Abstract

Background: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery.

Methods: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode.

Results: Ppeak was significantly reduced with the PCV-VG mode (19.6 ± 2.5 cmH2O) compared with the VCV mode (23.2 ± 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 ± 145.1 mmHg; VCV, 328.1 ± 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 ± 85.4 vs. 443.9 ± 85.9 ml; P = 0.035).

Conclusions: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.

Keywords: Airway pressure; Arterial oxygenation; One-lung ventilation; Pressure-controlled ventilation-volume guaranteed.

Figures

Fig. 1
Fig. 1
Consort diagram depicts the flow of participants.

References

    1. Seok JH, Kim EJ, Ban JS, Lee SG, Lee JH, Seo DM, et al. Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate: A case report. Korean J Anesthesiol. 2013;65:80–84.
    1. Lee DK, Kim YM, Kim HZ, Lim SH. Right upper lobe tracheal bronchus: anesthetic challenge in one-lung ventilated patients: A report of three cases. Korean J Anesthesiol. 2013;64:448–450.
    1. Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558–1565.
    1. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 1849.
    1. Gal TJ. Con: low tidal volumes are indicated during one-lung ventilation. Anesth Analg. 2006;103:271–273.
    1. Brodsky JB, Lemmens HJ. Left double-lumen tubes: clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth. 2003;17:289–298.
    1. Tuğrul M, Camci E, Karadeniz H, Sentürk M, Pembeci K, Akpir K. Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia. Br J Anaesth. 1997;79:306–310.
    1. Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery. Anesth Analg. 2007;104:1029–1033.
    1. Heimberg C, Winterhalter M, Strüber M, Piepenbrock S, Bund M. Pressure-controlled versus volume-controlled one-lung ventilation for MIDCAB. Thorac Cardiovasc Surg. 2006;54:516–520.
    1. Prella M, Feihl F, Domenighetti G. Effects of short-term pressure controlled ventilation on gas exchange, airway pressures, and gas distribution in patients with acute lung injury/ARDS: comparison with volume-controlled ventilation. Chest. 2002;122:1382–1388.
    1. MacIntyre NR. New modes of mechanical ventilation. Clin Chest Med. 1996;17:411–421.
    1. Maeda Y, Fujino Y, Uchiyama A, Matsuura N, Mashimo T, Nishimura M. Effects of peak inspiratory flow on development of ventilator-induced lung injury in rabbits. Anesthesiology. 2004;101:722–728.
    1. Keszler M. Volume-targeted ventilation. Early Hum Dev. 2006;82:811–818.
    1. Boules NS, Ghobrial HZ. Efficiency of the newly introduced ventilatory mode "pressure controlled ventilation-volume guaranteed" in thoracic surgery with one lung ventilation. Egypt J Anaesth. 2011;27:113–119.
    1. Tsuno K, Miura K, Takeya M, Kolobow T, Morioka T. Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures. Am Rev Respir Dis. 1991;143:1115–1120.
    1. Parker JC, Hernandez LA, Peevy KJ. Mechanisms of ventilator induced lung injury. Crit Care Med. 1993;21:131–143.
    1. Fernandez-Perez ER, Sprung J, Afessa B, Warner DO, Vachon CM, Schroeder DR, et al. Intraoperative ventilator settings and acute lung injury after elective surgery: a nested case control study. Thorax. 2009;64:121–127.
    1. Slinger P. Pro: low tidal volume is indicated during one-lung ventilation. Anesth Analg. 2006;103:268–270.
    1. Stewart DJ, Martin-Uncar AE, Edwards JG, West K, Waller DA. Extra-pleural pneumonectomy for malignant mesothelioma: the risks of induction chemotherapy, right-sided procedures and prolonged operations. Eur J Cardiothorac Surg. 2005;27:373–378.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅