Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position

Abstract

The study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury.Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928

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

“…PCV allows the ventilator to maintain pressure at the airway opening for a specified period of time (14)(15)(16)(17). As such, the final tidal volume and flow rate are affected by compliance, airway resistance, and spontaneous breathing.…”

Effects of individualized PEEP on postoperative delirium among older patients in prone position: study protocol for a prospective randomized controlled trial

“…However, applying a low V T with a fixed or insufficient PEEP for all patients is inappropriate because this may lead to atelectrauma [32]. Our team found that employing individualized PEEP can improve oxygenation and reduce inflammatory markers compared with fixed PEEP strategies in patients undergoing thoracoscopic and laparoscopic surgery [11,12]. Hence, we assume that individualized PEEP can prevent POD among elderly surgical patients in prone position by increasing rSO 2 and reducing inflammation.…”

“…Intraoperative lung-protective ventilation strategies, including low tidal volumes (V T ), PEEP, and recruitment maneuvers (RM), have been proved to alleviate lung injury and prevent POD [4,10]. Our previous studies have shown that individualized PEEP combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) mode could mitigate lung damage, and lead to favorable oxygenation in patients undergoing thoracoscopic surgery and laparoscopic surgery [11,12]. Recent studies demonstrated that the application of PEEP could induce significant increases in rSO 2 [4,13].…”

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

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