Comparison of volume-controlled and pressure-controlled ventilation on respiratory mechanics in laparoscopic bariatric surgery: randomized clinical trial
Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico
Erhan Ozyurt, Ali Sait Kavakli, Nilgun Kavrut Ozturk
Abstract
It is not clear which mechanical ventilation mode should be used in bariatric surgery, one of the treatment options for patients with obesity.
Objectives
To compare volume-controlled ventilation and pressure-controlled ventilation in terms of respiratory mechanics and arterial blood gas values in patients undergoing laparoscopic bariatric surgery.
Methods
Sixty-two patients with morbid obesity scheduled for gastric bypass were included in this study. Their ideal body weights were calculated during preoperative visits, and patients were divided into two groups, volume-controlled ventilation and pressure-controlled ventilation. The patients were ventilated in accordance with a previously determined algorithm. Mechanical ventilation parameters and arterial blood gas analysis were recorded 5minutes after induction, 30minutes after pneumoperitoneum, and at the end of surgery. Also, the dynamic compliance, inspired O2 pressure/fractional O2 ratio, and alveolar-arterial oxygen gradient pressure were calculated.
Results
Peak airway pressures were lower in patients ventilated in pressure-controlled ventilation mode at the end of surgery (p = 0.011). Otherwise, there was no difference between groups in terms of intraoperative respiratory parameters and arterial blood gas analyses.
Keywords
Resumo
Justificativa
O modo de ventilação mecânica que deve ser usado em cirurgia bariátrica, uma das opções de tratamento para pacientes com obesidade, ainda não foi definido.
Objetivos
Comparar as ventilações controladas por volume e por pressão em termos de mecânica respiratória e dos valores da gasometria arterial em pacientes submetidos à cirurgia bariátrica laparoscópica.
Métodos
Foram inclu¡dos neste estudo 62 pacientes com obesidade mórbida programados para bypass gástrico. Seus pesos corporais ideais foram calculados durante as consultas pré-operatórias e os pacientes foram divididos em dois grupos: ventilação controlada por volume e ventilação controlada por pressão. Os pacientes foram ventilados de acordo com um algoritmo previamente determinado. Os parâmetros da ventilação mecânica e as análises da gasometria arterial foram registrados 5 minutos após a indução, 30 minutos após o pneumoperitônio e ao final da cirurgia. Além disso, a complacência dinâmica, a pressão e a fração de oxigênio inspirado e a pressão do gradiente alvéolo-arterial de oxigênio foram calculados.
Resultados
As pressões de pico das vias aéreas foram menores nos pacientes ventilados no modo de ventilação controlada por pressão ao final da cirurgia (p = 0,011). Exceto por esse aspecto, não houve diferença entre os grupos quanto aos parâmetros respiratórios intraoperatórios e às gasometrias arteriais.
Conclusões
O modo de ventilação controlada por pressão não é superior ao modo de ventilação controlada por volume em pacientes de cirurgia bariátrica laparoscópica.
Palavras-chave
References
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