ABSTRACT
Objective:To explore the effects of pressure controlled ventilation-volume guaranteed (PCV-VG) mode on intraoperative pulmonary ventilation and postoperative pulmonary complications (PPC) in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty patients of American Society of Anesthesiologists (ASA) classification Ⅱor Ⅲ, aged 65-80 years old, with body mass index (BMI) 18-30 kg/m 2, received thoracoscopic lobectomy under general anesthesia from November 2021 to June 2022 in the Second Hospital of Shanxi Medical University were recruited. The patients were divided into PCV-VG and volume-controlled ventilation (VCV) groups using the randomized number table method, with 30 patients in each group. The ventilatory parameters of two-lung ventilation were set to respiratory rate (RR) at 10-12 breaths/min, with a tidal volume (VT) of 8 ml/kg (ideal body weight). The ventilatory parameters of one-lung ventilation (OLV) were set at 12-16 breaths/min, with a VT of 6 ml/kg (IBW). The peak airway pressure (Ppeak), plateau airway pressure (Pplat), driving pressure (ΔP), dynamic lung compliance (Cdyn), end-tidal carbon dioxide (ETCO 2), heart rate (HR), mean arterial pressure (MAP), partial pressure of oxygen (PaO 2) and partial pressure of carbon dioxide (PaCO 2) were obtained at 1 min before OLV (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The incidence and severity of PPC, chest tube duration time and postoperative hospital stay time were recorded. Results:The Ppeak, Pplat and ΔP were higher and Cdyn was lower in both groups at T 1-T 2 than at T 0 (all P<0.001). The Ppeak, Pplat and ΔP were higher and Cdyn was lower in PCV-VG group than in VCV group (all P<0.05). There were no statistical differences in HR, MAP, ETCO 2, PaO 2 and PaCO 2 between the two groups (all P > 0.05). There were no statistical differences in the incidence of PPC [43.3% (13/30) vs. 30.0% (9/30)] and chest tube duration time [(4.4±0.9) d vs. (4.2±1.2) d] between VCV group and PCV-VG group (all P>0.05). Compared with VCV group, the proportion of patients with ≥grade 2 PPC was lower in PCV-VG group [10.0% (3/30) vs. 36.7% (11/30), χ2=5.96, P<0.05]. The postoperative hospital stay time in PCV-VG group was shorter than that in VCV group [(6.4±1.3) d vs. (8.0±1.9) d, t = 4.85, P<0.05]. Conclusions:PCV-VG mode can effectively reduce the severity of PPC, shorten the postoperative hospital stay time and improve the prognosis in elderly patients undergoing thoracoscopic lobectomy.
ABSTRACT
BACKGROUND: The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV).METHODS: The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCV-VG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP (5 cmH₂O; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure (P(peak)), mean airway pressure (P(mean)), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP (5 cmH₂O), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more.RESULTS: The P(peak) was significantly lower in group TV6 (19.3±.3 cmH₂O) than in group TV8 (21.8±3.1 cmH₂O) and group TV6+PEEP (20.1±3.4 cmH₂O). PaO₂ was significantly higher in group TV8 (242.5±111.4 mmHg) than in group TV6 (202.1±101.3 mmHg) (p=0.044). There was no significant difference in PaO₂ between group TV8 and group TV6+PEEP (226.8±121.1 mmHg). However, three patients in group TV6 were dropped from the study because PaO₂ was lower than 80 mmHg after ventilation.CONCLUSION: It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with 5 cmH₂O PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.
Subject(s)
Humans , Blood Gas Analysis , One-Lung Ventilation , Oxygen , Positive-Pressure Respiration , Thoracic Surgery , Tidal Volume , Ventilation , Ventilators, MechanicalABSTRACT
Objective To explore the clinical effectiveness of pressure-controlled ventilation-volume guar-anteed(PCV-VG)in obese patients with obstructive sleep apnea syndrome(OSAS)during uvulopalatopharyngo-plasty. Methods 40 obese patients(BMI≥30 kg/m2)with OSAS scheduled for uvulopalatopharyngoplasty under general anesthesia were randomly divided into two groups of volume-controlled ventilation(group V,n = 20)and pressure-controlled ventilation-volume guaranteed(group P,n=20). The heart rate(HR),mean arterial pressure (MAP),arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbondioxide(PaCO2)were recorded before induction of anesthesia without oxygen inhalation(T0),30 min(T1)and 1 h(T2)after tracheal intubation,and 30 min after extubation(T3). The peak airway pressure(Ppeak),airway resistance(Raw),thoracic compliance (CL),oxygenation index (OI) and respiratory index (RI) were also calculated at T1 and T2 under observation of recovery. Results There were no obvious differences between the two groups of patients before anesthesia and after recovery. Compared with the group V ,PaCO2 ,PPEAK ,Raw at T1 ,T2 and RI at T1 ~ T3 of the group P decreased(P<0.05),while CL at T1,T2 and PaO2,OI at T1~T3 increased(P<0.05). There were no sig-nificant differences in HR ,MAP at the above time points. Conclusions Compared with volume-controlled venti-lation,PCV-VG can effectively enhance thoracic compliance,lower inspiratory pressure and airway resistance ,and decrease intrapulmonary shunt ,which is conductive to improve arterial oxygenation and gas exchange in obese patients with OSAS.
ABSTRACT
Objective The aim of this study was to explore the effects of volume controlled ventilation (VCV),pressure controlled ventilation(PCV)and pressure controlled ventilation-volume guaranteed (PCV-VG)on respiration and circulation in elderly patients undergoing thoracic surgery. Methods Thirty-six elderly patients who underwent thoracic surgery were enrolled in our study. Patients were divided into VCV,PCV and PCV-VG groups according to randomized design. The hemodynamic and respiratory data and the arterial blood gases had been recorded in the pre-operation,20 min,40 min,60 min after OLV and 20 min after the resumption of two lung ventilation. Results Compared with VCV group,Ppeak value was significantly lower in PCV and PCV-VG groups(P 0.05). Conclusion Compared with VCV,the use of PCV and PCV-VG have significant advantages in the operative oxygenation and airway pressure for elderly patients undergoing OLV.
ABSTRACT
BACKGROUND: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. METHODS: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode. RESULTS: P(peak) was significantly reduced with the PCV-VG mode (19.6 +/- 2.5 cmH2O) compared with the VCV mode (23.2 +/- 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 +/- 145.1 mmHg; VCV, 328.1 +/- 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 +/- 85.4 vs. 443.9 +/- 85.9 ml; P = 0.035). CONCLUSIONS: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.
Subject(s)
Humans , Anesthesia , Body Weight , Bronchoscopes , Lung , One-Lung Ventilation , Oxygen , Propofol , Thoracic Surgery , Tidal Volume , VentilationABSTRACT
BACKGROUND: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. METHODS: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode. RESULTS: P(peak) was significantly reduced with the PCV-VG mode (19.6 +/- 2.5 cmH2O) compared with the VCV mode (23.2 +/- 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 +/- 145.1 mmHg; VCV, 328.1 +/- 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 +/- 85.4 vs. 443.9 +/- 85.9 ml; P = 0.035). CONCLUSIONS: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.