Effects of Short-term Pressure-Controlled Ventilation on Gas Exchange, Airway Pressures, and Gas Distribution in Patients with Acute Lung Injury/ARDS

Prella, Maura; Feihl, F.; Domenighetti, Guido

doi:10.1378/chest.122.4.1382

Cited by 133 publications

(85 citation statements)

References 33 publications

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“…Additionally, the rapid alveolar inflation caused by the high initial flow rate in PCV can avoid regional overdistension and lead to better ventilation perfusion matching (19). Though there were a few studies compared PCV and VCV mode during OLV, but very few had evaluated the oxygenation index and postoperative lung complications between these two ventilation modes especially under PV strategy which is highly recommended during OLV.…”

Section: Discussionmentioning

confidence: 99%

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

Zhu¹,

Fang²,

Ling³

et al. 2017

J. Thorac. Dis.

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Background: It is controversial as to which ventilation mode is better during one-lung ventilation (OLV). This study was designed to figure out whether there was any difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) on oxygenation and postoperative complications under the condition of protective ventilation (PV).Methods: Sixty-five patients undergoing video-assisted thoracoscopic lobectomy were randomized into two groups. Patients in group V received VCV mode during OLV while patients in group P received PCV.The tidal volume (VT) in both groups was 6 mL per predicted body weight (PBW). Positive end-expiratory pressure (PEEP) was set at the level of 5 cmH 2 O in both groups. Arterial gas analysis were performed preoperatively with room air (T 0 ), at 15 mins (T 1 ) and 1 h (T 2 ) after OLV, at the end of OLV (T 3 ), 30 min after PACU admission (T 4 ), 24 h after surgery (post-operative day 1, POD 1 ) and 48 h after surgery (postoperative day 2, POD 2 ). Peak inspiratory airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at T 1 , T 2 and T 3 . The perioperative complications were also recorded.Result: Sixty-four patients completed this study. Ppeak in group V was significantly higher than that in group P (T 1 22.3±2.9 vs. 18.7±2.1 cmH 2 O; T 2 22.2±2.8 vs. 18.7±2.6 cmH 2 O). There were no differences with Pplat and intraoperative oxygenation index (T 1 203.3±109.7 vs. 198.1±93.4; T 2 216.8±79.1 vs. 232.1±101.4).The postoperative oxygenation index (T 4 525.0±160.9 vs. 520.7±127.1, post-operative day 1 (POD 1 ) 452.1±161.3 vs. 446.1±109.1; post-operative day 2 (POD 2 ) 403.8±93.4 vs. 396.7±92.8) and postoperative complications were also comparable between these two groups.Conclusions: When they were utilized during OLV, PCV and VCV had the same performance on the intraoperative oxygenation and postoperative complications under the condition of PV. J Thorac Dis 2017;9(5):1303-1309 jtd.amegroups.com ventilation (PCV) with low VT (6 mL/kg) was associated with lower incidence of postoperative lung dysfunction than volume controlled ventilation (VCV) with large VT (10 mL/kg). In 2007, Schultz et al. (5) published recommendations on intraoperative VT and suggested utilizing lower VT (≤6 mL/kg) in patients with abnormal lungs and/or risk factors for ALI.With further studying of small VT ventilation, some new findings came out. Blum et al. (6) showed that the incidence of postoperative ARDS was 0.2% in a general surgical population and the intraoperative risk factor included driver pressure instead of low tide volume. In thoracic surgery, the expected incidence of postoperative ALI was as high as 4.2% (7) and the independent risk factors included intraoperative ventilatory pressure index instead of VT. designed a study to prove their hypothesis that higher VT would be associated with higher risk of respiratory failure secondary to ALI, but the result showed that mean first hour peak airway pressure but not VT was associated with ALI. The clinical resea...

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Section: Discussionmentioning

confidence: 99%

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

Zhu¹,

Fang²,

Ling³

et al. 2017

J. Thorac. Dis.

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“…Therefore, during OLV in the prone position for robot-assisted esophagectomy, high inspiratory pressures should be avoided, not only because these pressures would divert pulmonary blood flow from ventilated lung areas to nonventilated lung areas but also because they would induce lung injury, resulting in oxygenation impairment [21,22]. Regarding the above-mentioned considerations, PCV seems to be a suitable mode of ventilation in this type of prone position without free abdominal and chest movements during OLV, because PCV has been widely used to reduce the lung injury associated with the increase in peak airway pressure in VCV [11,23]. PCV uses a decelerating inspiratory flow delivery method, which reaches quickly the highest possible value at the initiation of inspiration with a preset pressure limitation and then the flow diminishes throughout inspiration according to the preset inspiratory pressure [24].…”

Section: Discussionmentioning

confidence: 99%

“…PCV uses a decelerating inspiratory flow delivery method, which reaches quickly the highest possible value at the initiation of inspiration with a preset pressure limitation and then the flow diminishes throughout inspiration according to the preset inspiratory pressure [24]. In this mode, initial rate of flow is the highest because driving pressure minus alveolar pressure gradient is maximal at the beginning of inspiration leading to a more rapid alveolar inflation than VCV, and thereby facilitating recruitment of unstable alveoli [11,25,26]. Also, the decelerating inspiratory flow pattern of the PCV has been known to reduce the peak airway pressure and allow a more homogeneous gas distribution, leading to a better preserved V/Q [11,12,25].…”

Section: Discussionmentioning

confidence: 99%

“…Although controversial, pressure-controlled ventilation (PCV) is associated with improved lung mechanics and oxygenation relative to volume-controlled ventilation (VCV) in patients who require OLV because of its high initial flow rate and decelerating inspiratory flow pattern [8][9][10][11][12]. However, this high initial flow may cause shearing and traction forces on the alveoli, and the efficacy of PCV during OLV in the prone position has not been validated [13].…”

Section: Introductionmentioning

confidence: 99%

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Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy

Choi

Shim

et al. 2009

Surg Endosc

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Background The prone position during robotic esophageal mobilization for minimally invasive esophagectomy (MIE) provides several advantages with regards to operative times, surgeon ergonomics, and surgical view; however, this technique requires one-lung ventilation (OLV). There are no guidelines about ventilatory modes during OLV in the prone position. We investigated the effects of volume-controlled (VCV) and pressurecontrolled ventilation (PCV) on oxygenation and intrapulmonary shunt during OLV in the prone position in patients who underwent robot-assisted esophagectomy. Methods Eighteen patients, no major obstructive or restrictive pulmonary disease, were allocated randomly to one of two groups. In the first group (n = 9), OLV was started by VCV and the ventilator was switched to PCV after 30 minutes. In the second group (n = 9), the modes of ventilation were performed in the opposite order in the prone position. Hemodynamic and respiratory variables were obtained during OLV at the end of each ventilatory mode. Results There were no significant differences in arterial oxygen tension (PaO 2 ), airway pressures, dynamic lung compliance, or physiologic dead space (Vd/Vt) during OLV between PCV and VCV in the prone position. Intrapulmonary shunt (Qs/Qt) was significantly lower with VCV than with PCV during OLV in the prone position (p = 0.044). Conclusion PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robotassisted esophagectomy and who have normal body mass index and preserved pulmonary function.Keywords Minimally invasive esophagectomy Á One-lung ventilation Á Oxygenation Á Prone position Á Pressure-controlled ventilation Á Volume-controlled ventilation Prone positioning during robotic mobilization of the esophagus for minimally invasive esophagectomy (MIE) provides several advantages, including shortened operative times and superior surgical view, at the cost of one-lung ventilation (OLV) [1][2][3]. Surgical positions considerably influence the deterioration speed and the nadir value of arterial oxygen tension (PaO 2 ) after the start of OLV [4]. The development of hypoxemia during OLV depends mainly on the intrapulmonary shunt (Qs/Qt) through the nonventilated lung and matching of the ratio of ventilation and perfusion (V/Q) in the ventilated lung. In contrast to the lateral decubitus position, OLV in the prone position is devoid of the beneficial effect of gravity on preferential redistribution of the pulmonary blood flow to the dependent areas of a lung, possibly resulting in increased V/Q mismatch [4,5]. Also, the prone position is frequently associated with decreased respiratory compliance and

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“…Prella, Feihl and Domenighetti (13) compared the potential clinical benefits of PCV versus VCV in ALI/ARDS patients regarding gas exchange, airway pressure and intrapulmonary gas distribution, on CT scans. In this study, no significant difference was found for PaO 2 , carbon dioxide partial pressure (PCO 2 ) and PaO 2 /FIO 2 between the PCV and VCV groups.…”

Section: Alveolar Recruitment Maneuversmentioning

confidence: 99%

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

Costa¹,

Rocha²,

Ribeiro³

2009

Rev. bras. ter. intensiva

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Effects of Short-term Pressure-Controlled Ventilation on Gas Exchange, Airway Pressures, and Gas Distribution in Patients with Acute Lung Injury/ARDS

Cited by 133 publications

References 33 publications

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

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