Driving pressure-guided ventilation improves homogeneity in lung gas distribution for gynecological laparoscopy: a randomized controlled trial

Abstract

To investigate whether driving pressure–guided ventilation could contribute to a more homogeneous distribution in the lung for gynecological laparoscopy. Chinese patients were randomized, after pneumoperitoneum, to receive either positive end expiratory pressure (PEEP) of 5 cm H2O (control group), or individualized PEEP producing the lowest driving pressure (titration group). Ventilation homogeneity is quantified as the global inhomogeneity (GI) index based on electrical impedance tomography, with a lower index implying more homogeneous ventilation. The perioperative arterial oxygenation index and respiratory system mechanics were also recorded. Blood samples were collected for lung injury biomarkers including interleukin-10, neutrophil elastase, and Clara Cell protein-16. A total of 48 patients were included for analysis. We observed a significant increase in the GI index immediately after tracheal extubation compared to preinduction in the control group (p = 0.040) but not in the titration group (p = 0.279). Furthermore, the GI index was obviously lower in the titration group than in the control group [0.390 (0.066) vs 0.460 (0.074), p = 0.0012]. The oxygenation index and respiratory compliance were significantly higher in the titration group than in the control group. No significant differences in biomarkers or hemodynamics were detected between the two groups. Driving pressure–guided PEEP led to more homogeneous ventilation, as well as improved gas exchange and respiratory compliance for patients undergoing gynecological laparoscopy.Trial Registration: ClinicalTrials.gov NCT04374162; first registration on 05/05/2020.

PCV‐VG combined individualized PEEP determination in one‐lung ventilated patients with PEEP step change direction: A randomized controlled trial

“…Previous studies have confirmed that both incremental and decremental titrations reduce intraoperative shunting; however, only decremental titration improves oxygenation and reduces the airway pressure fluctuations required for pulmonary ventilation 26 . Another recent study suggested that incremental PEEP titration also improves oxygenation 27 and lung gas distribution uniformity in patients undergoing gynecologic laparoscopy 28 . Therefore, patients who underwent OLV during thoracoscopic surgery were included in this study and were studied in conjunction with personalized PEEP titration and PCV‐VG.…”

Effect of target-controlled pressure-controlled ventilation on percutaneous nephrolithotripsy patients under general anesthesia: a retrospective study

“…Recent studies of prone position surgery have demonstrated that PCV ventilation strategies can reduce the severity of lung injury (5,6). However, the PCV ventilation strategy also has shortcomings; for instance, tidal volume is difficult to control, and it is relatively challenging to judge respiratory mechanical changes (18)(19)(20). During PCV, the preset pressure level is reached at a higher initial inspiratory flow rate at the beginning of the inspiratory process, which decreases exponentially with the inspiratory time until the end of the inspiratory process.…”

Effect of driving pressure on early postoperative lung gas distribution in supratentorial craniotomy: a randomized controlled trial

“…The higher compliance and lower DP obtained strongly suggested minimizing lung functional overdistention and collapse. DP scales the tidal volume dependence of the functional lung size and PEEP, so individualizing the ventilatory settings intraoperatively and achieving an optimum DP adapted to the functional lung size is important [ 31 ]. This study supported the idea that a fixed PEEP is not suitable due to the individual characteristics of the patient and surgery [ 16 , 32 , 33 ].…”