Comparison of volume-controlled, pressure-controlled, and pressure-controlled volume-guaranteed ventilation during robot-assisted laparoscopic gynecologic surgery in the Trendelenburg position

Lee, Jung Min; Lee, Soo Kyung; Rhim, Chae Chun; Seo, Kwon Hui; Han, Minsu; Kim, Sang Hyun; Park, Eun Young

doi:10.7150/ijms.49253

Cited by 26 publications

(25 citation statements)

References 27 publications

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“…Of those, 351 had to be excluded, resulting in 21 publications that were full-text assessed for eligibility. Four publications had to be excluded, finally resulting in 17 studies that underwent the following qualitative evaluation [ 6 , 7 , 8 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. A flow chart of the search strategy and study selection are shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Schick

Dusse

Eckardt

et al. 2021

JCM

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For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

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Section: Resultsmentioning

confidence: 99%

Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Schick

Dusse

Eckardt

et al. 2021

JCM

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show abstract

“… 3 Moreover, PCV-VG improves respiratory dynamics in robot-assisted laparoscopic gynecologic surgery with Trendelenburg position. 11 Importantly, PCV-VG decreases the release of norepinephrine, reduces the inflammatory response and lung injury, protects the lung function of elderly patients with one-lung ventilation in thoracotomy. 12 , 13 The above results provide a basis for the study of PCV-VG in pediatric laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Pressure-Controlled Volume-Guaranteed Ventilation Improves Respiratory Dynamics in Pediatric Patients During Laparoscopic Surgery: A Prospective Randomized Controlled Trial

Liu

Cao

Zhang

et al. 2021

IJGM

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Purpose Pressure-controlled volume-guaranteed (PCV-VG) combines the characteristics of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV). It has been reported that PCV-VG decreases airway pressure and improves oxygenation among the adult group. In this study, the respiratory dynamics of PCV-VG and VCV are compared in pediatric patients ventilated with laryngeal mask airway and underwent laparoscopic hernia of the sac ligation. Patients and Methods Sixty-four pediatric patients were included in this prospective, randomized clinical trial. Pediatric patients were randomly allocated to receive VCV and PCV-VG ventilation during the general anesthesia. The hemodynamic and respiratory variables were recorded at the time when laryngeal mask airway was placed, pneumoperitoneum began, 5 mins after pneumoperitoneum began, pneumoperitoneum ended, and the operation ended respectively. The respiratory adverse events were recorded after the operation and on the first day after the operation. In this study, respiratory adverse events are defined as cough, hoarseness, hypoxemia, laryngospasm, bronchospasm, and sore throat. Results There was no statistical difference in hemodynamic variables at all time points between the two groups. Compared to the VCV group, peak airway pressure (Ppeak) and plateau airway pressure in the PCV-VG group decreased significantly. Pulmonary dynamic compliance (Cydn) in the PCV-VG group was significantly higher than that in the VCV group. The respiratory adverse events appeared to have no statistical difference between VCV and PCV groups. Conclusion PCV-VG provides a lower Ppeak and better Cydn in pediatric patients compared with the VCV group during laparoscopic surgery. The results suggested that PCV-VG may be a superior way of mechanical ventilation for pediatric patients who ventilated with laryngeal mask airway and experienced laparoscopic surgery.

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“…Recently, the use of the DCV mode, such as the AutoFlow or PCV-VG (pressure-controlled ventilation volume guaranteed), has been reported to be useful in maintaining lower PAWP during laparoscopic surgeries requiring the Trendelenburg position, compared with VCV, where the patient is ventilated using tracheal intubation [ 5 , 6 ]. The advantage of DCV over PCV is that the former can maintain adequate tidal volume throughout the procedure, even if lung compliance is altered.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, DCV has the advantages of both PCV and volume-controlled ventilation (VCV) and can, therefore, prevent PAWP elevation and ensure target tidal volume even when lung compliance changes, such as during laparoscopy and in the Trendelenburg position [ 5 ]. During laparoscopic surgery in the Trendelenburg position with tracheal intubation, DCV has been reported to result in lower PAW P values than VCV [ 5 , 6 ]. Thus, suppressing PAWP with AutoFlow ventilation may prevent airway leak during laparoscopic gynecological surgery with pLMA.…”

Section: Introductionmentioning

confidence: 99%

AutoFlow® versus volume-controlled ventilation for laparoscopic gynecological surgery using LMA® ProSeal™: a randomized controlled trial

et al. 2021

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Background During laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal. Methods This single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35–40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6–0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann–Whitney U test for PAWP and Fisher’s exact test for comparing airway leak among the groups. Results Data from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15–18) cmH2O vs. 18 (17–19) cmH2O; P < 0.001]. Similarly, patients in the AutoFlow group showed lower PAWP at the other three timepoints measured. Airway leak occurred in four patients in the AutoFlow group and in two patients in the VCV group; however, this incidence was not significantly different (P = 0.68). Conclusions Even though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal. Trial registration UMIN Clinical Trials Registry, identifier UMIN000023173.

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Comparison of volume-controlled, pressure-controlled, and pressure-controlled volume-guaranteed ventilation during robot-assisted laparoscopic gynecologic surgery in the Trendelenburg position

Cited by 26 publications

References 27 publications

Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Pressure-Controlled Volume-Guaranteed Ventilation Improves Respiratory Dynamics in Pediatric Patients During Laparoscopic Surgery: A Prospective Randomized Controlled Trial

AutoFlow® versus volume-controlled ventilation for laparoscopic gynecological surgery using LMA® ProSeal™: a randomized controlled trial

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