<p>Lung ultrasound score-based perioperative assessment of pressure-controlled ventilation-volume guaranteed or volume-controlled ventilation in geriatrics: a prospective randomized controlled trial</p>

Abstract

Purpose Recent studies have shown the potential benefits of pressure-controlled ventilation-volume guaranteed (PCV-VG) compared to volume-controlled ventilation (VCV), but the results were not impressive. We assessed the effects of PCV-VG versus VCV in elderly patients by using lung ultrasound score (LUS). Patients and methods Elderly patients (aged 65–90 years) scheduled for hip joint surgery were randomly assigned to either the PCV-VG or VCV group during general anesthesia. LUS and mechanical ventilator parameters were evaluated before induction, 30 mins after a semi-lateral position change, during supine repositioning before awakening, and 15 mins after arrival to the post-anesthesia care unit (PACU). Pulmonary function tests were performed before and after surgery. Other recovery indicators were also assessed in the PACU. Results A total of 76 patients (40 for PCV-VG and 36 for VCV) were included this study. Demographic data showed no significant difference between the two groups. In both groups, LUSs before induction were significantly lower than those at other time points. LUSs of the VCV group were significantly increased during perioperative periods compared with the PCV-VG group ( p =0.049). Visualized LUS modeling suggested an intuitive difference in the two groups and unequal distribution in lung aeration. Higher dynamic compliance and lower inspiratory peak pressure were observed in the PVC-VG group compared to the VCV group (33.54 vs 27.36, p <0.001; 18.93 vs 21.19, p <0.001, respectively). Postoperative forced vital capacity of the VCV group was lower than that of PCV-VG group, but this result was not significant (2.06 vs 1.79, respectively; p =0.091). The other respiratory data are comparable between the two groups. Conclusion The PCV-VG group showed better LUS compared with the VCV group. Moreover, LUS modeling in both groups suggests non-homogeneous and positional change in lung aerations during surgery. Clinical trial registration This study was registered at the UMIN clinical trials registry (unique trial number: UMIN000029355; registration number: R000033510)

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

“…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 .…”

Effects of Intraoperative Ventilation Strategy on Perioperative Atelectasis Assessed by Lung Ultrasonography in Patients Undergoing Open Abdominal Surgery: a Prospective Randomized Controlled Study

“… 24 In previous research on LUS scores based on ventilation mode in elderly patients, a PCV-VG group had lower LUS scores compared to a VCV group, which suggests that the distribution of ventilation and LUS score may vary depending on the ventilation mode. 25 …”

Successful intraoperative management in patients with abdominal compartment syndrome induced by giant liposarcomas

“…PCV-VG is a mechanical ventilation mode that guarantees TV with the lowest possible pressure using decelerating flow for patients undergoing surgery. [ 13 14 15 ] As for our 2 cases, intraoperative high airway pressures and barotrauma were also of great concern, therefore, PCV-VG ventilation mode was adjusted for each patient. It was also reported that spontaneous ventilation should be maintained for as long as possible and that the inspiratory pressure should be kept under 20 cmH 2 0 even if muscle relaxants were used.…”