Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico

Özyurt, Erhan; Kavakli, Ali Sait; Öztürk, Nilgün

doi:10.1016/j.bjan.2019.08.005

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…In 11 randomized trials ( 21 , 23 , 24 , 26 , 28 – 31 , 33 , 34 , 36 ), a total of 630 patients with obesity were reported to have lung compliance values across 10 ventilation strategies ( Figure 2 ). The quasistatic compliance of the respiratory system was evaluated as:…”

Section: Resultsmentioning

confidence: 99%

“…In summary, 1 study ( 42 ) was assessed as having a high bias risk and was excluded. Two studies were assessed as being unclear ( 33 , 35 ), and the rest deemed to be low risk ( 12 , 20 – 32 , 34 , 36 – 41 ). All studies were symmetrically distributed within the funnel plot, indicating no publication bias (supporting information Figures S9–S11 ).…”

Section: Resultsmentioning

confidence: 99%

“…There were 17 RCTs (20)(21)(22)(23)(24)(25)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) involving a total of 985 patients with obesity, which assessed the MD of the overall effect size of the intraoperative PaO 2 /FiO 2 across the 11 ventilation strategies (Figure 2). The network meta-analysis showed that the ventilation strategy volume-controlled ventilation with individualized positive end-expiratory pressure and recruitment maneuver (VCV+PEEPind+RM) was more efficacious in improving PaO 2 /FiO 2 than pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), volume-controlled ventilation with recruitment maneuver (VCV+RM), VCV+lowPEEP or volume-controlled ventilation with lower positive expiratory end pressure and recruitment maneuver (VCV+lowPEEP+RM), MD [95% CI] and [quality of evidence]: 162.…”

Section: Intraoperative Pao 2 /Fio 2 Ratiomentioning

confidence: 99%

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Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Wang

Zeng²,

Zhang³

et al. 2022

Front. Immunol.

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ObjectivesNew ventilation modes have been proposed to support the perioperative treatment of patients with obesity, but there is a lack of consensus regarding the optimal strategy. Therefore, a network meta-analysis update of 13 ventilation strategies was conducted to determine the optimal mode of mechanical ventilation as a protective ventilation strategy decreases pulmonary atelectasis caused by inflammation.MethodsThe following databases were searched: MEDLINE; Cochrane Library; Embase; CINAHL; Google Scholar; and Web of Science for randomized controlled trials of mechanical ventilation in patients with obesity published up to May 1, 2022.ResultsVolume-controlled ventilation with individualized positive end-expiratory pressure and a recruitment maneuver (VCV+PEEPind+RM) was found to be the most effective strategy for improving ratio of the arterial O2 partial pressure to the inspiratory O2 concentration (PaO2/FiO2), and superior to pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), volume-controlled ventilation with recruitment maneuver (VCV+RM), volume-controlled ventilation with low positive end-expiratory pressure (VCV+lowPEEP), volume-controlled ventilation with lower positive expiratory end pressure (PEEP) and recruitment maneuver (VCV+lowPEEP+RM), and the mean difference [MD], the 95% confidence intervals [CIs] and [quality of evidence] were: 162.19 [32.94, 291.45] [very low]; 180.74 [59.22, 302.27] [low]; 171.07 [40.60, 301.54] [very low]; 135.14 [36.10, 234.18] [low]; and 139.21 [27.08, 251.34] [very low]. Surface under the cumulative ranking curve (SUCRA) value showed VCV+PEEPind+RM was the best strategy for improving PaO2/FiO2 (SUCRA: 0.963). VCV with high positive PEEP and recruitment maneuver (VCV+highPEEP+RM) was more effective in decreasing postoperative pulmonary atelectasis than the VCV+lowPEEP+RM strategy. It was found that volume-controlled ventilation with high positive expiratory end pressure (VCV+highPEEP), risk ratio [RR] [95% CIs] and [quality of evidence], 0.56 [0.38, 0.81] [moderate], 0.56 [0.34, 0.92] [moderate]. SUCRA value ranked VCV+highPEEP+RM the best strategy for improving postoperative pulmonary atelectasis intervention (SUCRA: 0.933). It should be noted that the quality of evidence was in all cases very low or only moderate.ConclusionsThis research suggests that VCV+PEEPind+RM is the optimal ventilation strategy for patients with obesity and is more effective in increasing PaO2/FiO2, improving lung compliance, and among the five ventilation strategies for postoperative atelectasis, VCV+highPEEP+RM had the greatest potential to reduce atelectasis caused by inflammation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021288941.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Intraoperative Pao 2 /Fio 2 Ratiomentioning

confidence: 99%

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Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Wang

Zeng²,

Zhang³

et al. 2022

Front. Immunol.

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Comparison of Pressure and Volume-Controlled Mechanical Ventilation in Laparoscopic Bariatric Surgery: A Randomized Crossover Trial

et al. 2022

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Background: The number of patients with obesity undergoing various surgeries is increasing annually, and ventilation problems are highly prevalent in these patients. Objectives: We aimed to evaluate ventilation effectiveness with pressure-controlled (PC) and volume-controlled (VC) ventilation modes during laparoscopic bariatric surgery. Methods: In this open-label randomized crossover clinical trial, 40 adult patients with morbid obesity candidates for laparoscopic bariatric surgery were assigned to VC-PC or PC-VC groups. Each patient received both ventilation modes sequentially for 15 min during laparoscopic surgery in a random sequence. Every 5 min, exhaled tidal volume, peak and mean airway pressure, oxygen saturation, heart rate, mean arterial pressure, and end-tidal CO2 were recorded. Blood gas analysis was done at the end of 15 min. Dynamic compliance, PaO2/FiO2 ratio, P (A-a) O2 gradient, respiratory dead space, and PaCO2-ETCO2 gradient were calculated according to the obtained results. Results: The study included 40 patients with a mean age of 35.13 ± 9.06 years. There were no significant differences in peak and mean airway pressure, dynamic compliance, and hemodynamic parameters (P > 0.05). There was no significant difference between the two ventilation modes in pH, PaCO2, PaO2, PaO2/FIO2, dead space volume, and D (A-a) O2 at different time intervals (P > 0.05). Conclusions: If low tidal volumes are used during adult laparoscopic bariatric surgery, mechanical ventilation with PC mode is not superior to VC mode.

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Comparação das ventilações controlada por volume e controlada por pressão na mecânica respiratória em cirurgia bariátrica laparoscópica: estudo clínico randômico

Cited by 2 publications

References 15 publications

Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: A network meta-analysis

Comparison of Pressure and Volume-Controlled Mechanical Ventilation in Laparoscopic Bariatric Surgery: A Randomized Crossover Trial

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