Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position
Comparação entre ventilação garantida por volume controlado por pressão e ventilação controlada por volume em pacientes obesos durante cirurgia laparoscópica ginecológica na posição de Trendelenburg
Melike Korkmaz Toker, Basak Altıparmak, Ali İhsan Uysal, Semra Gumus Demirbilek
Abstract
Background and objectives
The aim of this study was to investigate the efficacy of the pressure-controlled, volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) modes for maintaining adequate airway pressures, lung compliance and oxygenation in obese patients undergoing laparoscopic hysterectomy in the Trendelenburg position.
Methods
Patients (104) who underwent laparoscopic gynecologic surgery with a body mass index between 30 and 40 kg.m−2 were randomized to receive either VCV or PCV-VG ventilation. The tidal volume was set at 8 mL.kg−1, with an inspired oxygen concentration of 0.4 with a Positive End-Expiratory Pressure (PEEP) of 5 mmHg. The peak inspiratory pressure, mean inspiratory pressure, plateau pressure, driving pressure, dynamic compliance, respiratory rate, exhaled tidal volume, etCO2, arterial blood gas analysis, heart rate and mean arterial pressure at 5 minutes after induction of anesthesia in the and at 5, 30 and 60 minutes, respectively, after pneumoperitoneum in the Trendelenburg position were recorded.
Results
The PCV-VG group had significantly decreased peak inspiratory pressure, mean inspiratory pressur, plateau pressure, driving pressure and increased dynamic compliance compared to the VCV group. Mean PaO2 levels were significantly higher in the PCV-VG group than in the VCV group at every time point after pneumoperitoneum in the Trendelenburg position.
Conclusions
The PCV-VG mode of ventilation limited the peak inspiratory pressure, decreased the driving pressure and increased the dynamic compliance compared to VCV in obese patients undergoing laparoscopic hysterectomy. PCV-VG may be a preferable modality to prevent barotrauma during laparoscopic surgeries in obese patients.
Keywords
Resumo
Justificativa e objetivos
O objetivo deste estudo foi investigar a eficácia dos modos de ventilação garantida por volume controlado por pressão (PCV-VG) e ventilação controlada por volume (VCV) para manter pressões adequadas nas vias aéreas, complacência pulmonar e oxigenação em pacientes obesos submetidos à histerectomia laparoscópica na posição de Trendelenburg.
Métodos
Cento e quatro pacientes submetidos à cirurgia ginecológica laparoscópica, com índice de massa corporal entre 30 e 40 kg.m−2, foram randomizados para receber ventilação com VCV ou PCV-VG. O volume corrente foi fixado em 8 mL.kg-1, com uma concentração inspirada de oxigênio de 0,4 e pressão positiva expiratória final (PEEP) de 5 mmHg. Registramos os seguintes parâmetros: pressão de pico inspiratório, pressão inspiratória média, pressão de platô, driving pressure, complacência dinâmica, frequência respiratória, volume corrente expirado, etCO2, gasometria arterial, frequência cardíaca e pressão arterial média aos 5, 30 e 60 minutos, respectivamente, após o pneumoperitônio na posição de Trendelenburg.
Resultados
O grupo PCV-VG apresentou uma redução significativa da pressão de pico inspiratório, pressão inspiratória média, pressão de platô, driving pressure e aumento da complacência dinâmica comparado ao grupo VCV. Os níveis médios de PaO2 foram significativamente maiores no grupo PCV-VG do que no grupo VCV em todos os momentos após o pneumoperitônio na posição de Trendelenburg.
Conclusões
O modo de ventilação PCV-VG limitou a pressão de pico inspiratório, diminuiu a driving pressure e aumentou a complacência dinâmica, comparado ao VCV em pacientes obesas submetidas à histerectomia laparoscópica. O PCV-VG pode ser uma modalidade preferida para prevenir o barotrauma durante cirurgias laparoscópicas em pacientes obesos.
Palavras-chave
References
1 V.L. Jacoby, A. Autry, G. Jacobson, et al. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches Obstet Gynecol, 114 (2009), pp. 1041-1048
2 N.T. Nguyen, B.M. Wolfe The physiologic effects of pneumoperitoneum in the morbidly obese Ann Surg, 241 (2005), pp. 219-226
3 M.D. Jensen, D.H. Ryan, C.M. Apovian, et al. Reprint: 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults J Am Pharm Assoc, 2014 (54) (2003), p. e3
4 L.E. Hodgson, P.B. Murphy, N. Hart Respiratory management of the obese patient undergoing surgery J Thorac Dis, 7 (2015), pp. 943-952
5 A. Fernandez-Bustamante, S. Hashimoto, A. Serpa Neto, et al. Perioperative lung protective ventilation in obese patients BMC Anesthesiology, 15 (2015), p. 56
6 M. Aldenkortt, C. Lysakowski, N. Elia, et al. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis Br J Anaesth, 109 (2012), pp. 493-502
7 O. Sen, M. Bakan, T. Umutoglu, et al. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position Springerplus, 5 (2016), p. 1761
8 M. Keszler Volume-targeted ventilation Early Hum Dev, 82 (2006), pp. 811-818
9 J. Pu, Z. Liu, L. Yang, et al. Applications of pressure control ventilation volume guaranteed during one-lung ventilation in thoracic surgery Int J Clin Exp Med, 7 (2014), pp. 1094-1098
10 L. Ball, M. Dameri, P. Pelosi Modes of mechanical ventilation for the operating room Best Pract Res Clin Anaesthesiol, 29 (2015), pp. 285-299
11 S.Y. Song, J.Y. Jung, M.S. Cho, et al. Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation Korean J Anesthesiol, 67 (2014), pp. 258-263
12 K. Mahmoud, A. Ammar, Z. Kasemy Comparison between pressure-regulated volume-controlled and volume-controlled ventilation on oxygenation parameters, airway pressures, and immune modulation during thoracic surgery J Cardiothorac Vasc Anesth, 31 (2017), pp. 1760-1766
13 N.S. Boules, H.Z. Ghobrial Efficiency of the newly introduced ventilatory mode “pressure controlled ventilation-volume guaranteed” in thoracic surgery with one lung ventilation Egypt J Anaesth, 27 (2011), pp. 113-119
14 J.M. Dion, C. McKee, J.D. Tobias, et al. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes Int J Clin Exp Med, 7 (2014), pp. 2242-2247
15 M. Oǧurlu, M. Küçük, F. Bilgin, et al. Pressure-controlled vs. volume-controlled ventilation during laparoscopic gynecologic surgery J Minim Invasive Gynecol, 17 (2010), pp. 295-300
16 O.M. Assad, A.A. El Sayed, M.A. Khalil Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position J Clin Anesth, 34 (2016), pp. 55-61
17 Z. Liu, X. Liu, Y. Huang, et al. Intraoperative mechanical ventilation strategies in patients undergoing one-lung ventilation: a meta-analysis Springerplus, 5, Springer International Publishing (2016), p. 1251
18 P. Cadi, T. Guenoun, D. Journois, et al. Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation Br J Anaesth, 100 (2008), pp. 709-716
19 K. Davis, R.D. Branson, R.S. Campbell, et al. Comparison of volume control and pressure control ventilation: Is flow waveform the difference? J Trauma - Inj Infect Crit Care, 41 (1996), pp. 808-814
20 J.J. Marini, S.A. Ravenscraft Mean airway pressure: Physiologic determinants and clinical importance - Part 2: clinical implications Crit Care Med, 20 (1992), pp. 1604-1616
21 E.A. Hirvonen, L.S. Nuutinen, M. Kauko Ventilatory effects, blood gas changes, and oxygen consumption during laparoscopic hysterectomy Anesth Analg, 80 (1995), pp. 961-966
22 A. De Jong, G. Chanques, S. Jaber Mechanical ventilation in obese ICU patients: from intubation to extubation Crit Care, 21 (2017), p. 63
23 M.B.P. Amato, M.O. Meade, A.S. Slutsky, et al. Driving pressure and survival in the acute respiratory distress syndrome N Engl J Med, 372 (2015), pp. 747-755
24 M. Briel, M. Meade, A. Mercat, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: Systematic review and meta-analysis JAMA, 303 (2010), pp. 865-873
25 G. Bugedo, J. Retamal, A. Bruhn Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care, 21 (2017), p. 199
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email