Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial

Abstract

Dual-controlled ventilation (DCV) combines the advantages of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning for robot-assisted laparoscopic radical prostatectomy (RALRP) has negative effects on the respiratory system. We hypothesized that the use of autoflow as one type of DCV can reduce these effects during RALRP. Eighty patients undergoing RALRP were randomly assigned to receive VCV or DCV. Arterial oxygen tension (PaO2) as the primary outcome, respiratory and hemodynamic data, and postoperative fever rates were compared at four time points: 10 min after anesthesia induction (T1), 30 and 60 min after the initiation of CO2 pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after supine positioning (T4). There were no significant differences in PaO2 between the two groups. Mean peak airway pressure (Ppeak) was significantly lower in group DCV than in group VCV at T2 (mean difference, 5.0 cm H2O; adjusted p < 0.001) and T3 (mean difference, 3.9 cm H2O; adjusted p < 0.001). Postoperative fever occurring within the first 2 days after surgery was more common in group VCV (12%) than in group DCV (3%) (p = 0.022). Compared with VCV, DCV did not improve oxygenation during RALRP. However, DCV significantly decreased Ppeak without hemodynamic instability.

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 .…”

“…Whenever postoperative events were investigated, most parameters did not show any significant differences between groups. Park et al reported significantly more postoperative fever in VCV-ventilated patients [ 7 ]. Mahmoud and colleagues reported significantly improved outcomes, like postoperative oxygenation and even a reduced ICU and hospital stay, in PCV-VG-ventilated patients compared with VCV [ 22 ].…”

“…For laparoscopy and the Trendelenburg position, research showed potential advantages for PCV-VG in the perioperative setting, e.g., in terms of improved oxygenation and reduced airway pressures [ 6 ]. However, other publications did not show an improved oxygenation for this new ventilation mode [ 7 ], and Sahutoglu even described a non-significant trend toward the more post-operative complications after the use of PCV-VG [ 8 ]. Other comparisons of PCV-VG in the perioperative setting, e.g., with PCV itself, are sparse and limited to three studies up to date.…”

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

“…In VCV, the ventilator delivers a constant preset tidal volume, and airway pressure is influenced by pulmonary compliance [3,4]. PCV provides a constant preset tidal volume by decelerating the flow, thereby achieving the desired tidal volume at lower Ppeak [9]. However, the tidal volume can vary as a result of decreased lung compliance, especially during transition from the supine to the Trendelenburg position, or during induction of pneumoperitoneum with CO2.…”

“…However, the tidal volume can vary as a result of decreased lung compliance, especially during transition from the supine to the Trendelenburg position, or during induction of pneumoperitoneum with CO2. Furthermore, there is a risk of hypoventilation or hyperventilation [9,10]. PCV-VG provides a target tidal volume by decelerating the flow, similar to PCV.…”