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

Abstract

BackgroundNot 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.MethodsWe 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.ResultsSix 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, I2 = 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.ConclusionsOur 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0238-6) contains supplementary material, which is available to authorized users.

Perioperative lung protective ventilation

“…Investigations into the superiority of PCV over volume controlled ventilation in the intraoperative setting to date have had marginal or conflicting results. For example, a recent meta-analysis of six RCTs of thoracic surgery patients reported that the use of PCV during OLV led to lower peak inspiratory pressures (weighted mean difference −4.91 cm H 2 O; P<0.0001) and a higher ratio of partial pressure of oxygen to fractional inspired oxygen concentration (weighted mean difference 11.04; P=0.04), although these differences are unlikely to be clinically significant 108. Small RCTs in laparoscopic bariatric surgery have yielded similar results 109110.…”

Recommendations for perioperative management of lung cancer patients with comorbidities

“…High airway pressures or tidal volumes during one-lung ventilation can lead to barotrauma and volutrauma in the contralateral lung. Low-pressure controlled one-lung ventilation can relieve such stress [14]. These management decisions should be made in consultation with an anesthesiologist.…”

The Effects of One-lung Ventilation on the Production of Endogenous Melatonin and NLRP3 Inflammasome-Related Inflammatory Cytokines in Patients Undergoing Laparoscopic Esophagectomy: A Prospective Randomized Double-Blind Controlled Study

“…However, clinical studies have shown that the extended use of OLV is an independent risk factor for postoperative pulmonary dysfunction [20]. Excessive stretching or repeated opening of lung tissues is an important cause of VILI during OLV [21]. A lung-protective strategy using low Vt along with PEEP during OLV was confirmed to improve postoperative pulmonary dysfunction [6].…”