Efficacy of PCV-VG mode for lung protective ventilation in patients requiring one-lung ventilation during thoracoscopic surgery / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of pressure-controlled volume-guaranteed (PCVVG) mode for lung protective ventilation in patients requiring one-lung ventilation (OLV) during thoracoscopic surgery.Methods Sixty patients,aged 50-70 yr,with body mass index of 18-26 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of esophageal cancer performed via video-assisted thoracoscope under general anesthesia,were divided into 2 groups (n=30 each) using a random number tablevolume-controlled ventilation group (group V) and PCV-VG group (group P).The ventilator settings were adjusted,with a tidal volume 10 ml/kg and respiratory rate 10-12 breaths/min during two-lung ventilation,and with a tidal volume 6 ml/kg and respiratory rate 12-16 breaths/min during OLV.The inspiratory/expiratory ratio was 1 ∶ 2,pressure restriction was 35 cmH2O,and 33％ oxygen was inhaled at 2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg.Visual analog scale score was maintained ≤ 3 after operation.After admission to the operation room (T0) and at 1,3 and 7 days after operation (T1-3),forced vital capacity (FVC),forced expiratory volume in first second (FEV1),and maximal mid-expiratory flow (MMEF) were measured,arterial blood samples were collected for blood gas analysis,arterial carbon dioxide partial pressure and arterial oxygen partial pressure (PaO2) were recorded,and alveolar-arterial oxygen tension difference (PA-a O2) was calculated.Clinical Pulmonary Infection Score was assessed at T1,T2 and T3.The chest tube removal time and length of postoperative hospital stay were recorded.Results Compared with the baseline at T0,FVC,FEV1,MMEF and PaO2 were significantly decreased,and PA-aO2 was increased at T1-3 in the two groups (P＜0.05).Compared with group V,FVC,FEV1,MMEF and PaO2 were significantly increased,PA-aO2 and Clinical Pulmonary Infection Score were decreased,and the chest tube removal time and length of postoperative hospital stay were shortened at T1-3 in group P (P＜0.05).Conclusion PCV-VG mode can achieve lung protective ventilation,which is helpful in improving outcomes in the patients requiring OLV during thoracoscopic surgery.