Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position

Toker, Melike Korkmaz; Altıparmak, Basak; Uysal, Ali İhsan; Demirbilek, Semra Gumus

doi:10.1016/j.bjane.2019.10.002

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Scientific Articles • Rev. Bras. Anestesiol. 69 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.bjane.2019.10.002 copy

Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

The aim of this study was to investigate the efficacy of the pressure-controlled, volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) modes for maintaining adequate airway pressures, lung compliance and oxygenation in obese patients undergoing laparoscopic hysterectomy in the Trendelenburg position.

Methods:

Patients (104) who underwent laparoscopic gynecologic surgery with a body mass index between 30 and 40 kg.m^-2 were randomized to receive either VCV or PCV-VG ventilation. The tidal volume was set at 8 mL.kg^-1, with an inspired oxygen concentration of 0.4 with a Positive End-Expiratory Pressure (PEEP) of 5 mmHg. The peak inspiratory pressure, mean inspiratory pressure, plateau pressure, driving pressure, dynamic compliance, respiratory rate, exhaled tidal volume, etCO₂, arterial blood gas analysis, heart rate and mean arterial pressure at 5 minutes after induction of anesthesia in the and at 5, 30 and 60 minutes, respectively, after pneumoperitoneum in the Trendelenburg position were recorded.

Results:

The PCV-VG group had significantly decreased peak inspiratory pressure, mean inspiratory pressur, plateau pressure, driving pressure and increased dynamic compliance compared to the VCV group. Mean PaO₂ levels were significantly higher in the PCV-VG group than in the VCV group at every time point after pneumoperitoneum in the Trendelenburg position.

Conclusions:

The PCV-VG mode of ventilation limited the peak inspiratory pressure, decreased the driving pressure and increased the dynamic compliance compared to VCV in obese patients undergoing laparoscopic hysterectomy. PCV-VG may be a preferable modality to prevent barotrauma during laparoscopic surgeries in obese patients.

KEYWORDS
Laparoscopy; Obesity; Mechanical ventilation; Lung compliance; General anesthesia

	Group VCV (n = 50)	Group PCV-VG (n = 50)	^a a Student's t test. p
Age (years)	50.5 ± 9.4	51 ± 7.7	0.79
BMI (kg. m^-2)	32.8 ± 2.07	33.1 ± 3.1	0.63
ASA physical status (II/III)	28/22	29/21
Duration of pneumoperitoneum (min)	132.5 ± 33.9	136.6 ± 42.2	0.59
Preoperative FEV₁ (% predicted)	94.3 ± 7.7	93.2 ± 9.8	0.54
Preoperative FVC (% predicted)	91.9 ± 7.6	91.9 ± 8.4	0.99

		T1	T2	T3	T4
PIP (cm H₂O)	PCV-VG	15.6 ± 2.8	24.6 ± 3.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	24 ± 3.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	25.04 ± 4.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.
PIP (cm H₂O)	VCV	15.9 ± 2.9	29.1 ± 3.4^b b p < 0.01 vs. T1 in each group.	28.5 ± 2.7^b b p < 0.01 vs. T1 in each group.	29.3 ± 4.2^b b p < 0.01 vs. T1 in each group.
Pmean (cm H₂O)	PCV-VG	8.1 ± 0.9	8.4 ± 1.6^a a p < 0.01 vs. the VCV group at the same time point.	9.3 ± 2.1^b b p < 0.01 vs. T1 in each group.	10 ± 1.9^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.
Pmean (cm H₂O)	VCV	8.2 ± 1.3	9.5 ± 1.5^b b p < 0.01 vs. T1 in each group.	9.9 ± 1.8^b b p < 0.01 vs. T1 in each group.	11.7 ± 1.2^b b p < 0.01 vs. T1 in each group.
Pplateau (cm H₂O)	PCV-VG	13.2 ± 2.8	21.9 ± 3.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	21.4 ± 3.3^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	22.4 ± 4.4^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.
Pplateau (cm H₂O)	VCV	13.6 ± 2.9	26.5 ± 3.5^b b p < 0.01 vs. T1 in each group.	25.4 ± 2.8^b b p < 0.01 vs. T1 in each group.	26.1 ± 4.4^b b p < 0.01 vs. T1 in each group.
Dp (cm H₂O)	PCV-VG	8.2 ± 2.8	16.9 ± 3.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	16.4 ± 3.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	17.3 ± 4.4^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.
Dp (cm H₂O)	VCV	8.6 ± 2.9	21.6 ± 3.6^a a p < 0.01 vs. the VCV group at the same time point.	20.4 ± 2.8^a a p < 0.01 vs. the VCV group at the same time point.	21.1 ± 4.4^a a p < 0.01 vs. the VCV group at the same time point.
Compliance (mL. cm^-1 H₂O)	PCV-VG	42.9 ± 6.1	23.9 ± 3.6^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.	22.7 ± 5.4^b b p < 0.01 vs. T1 in each group. ,^c c p < 0.05 vs. the VCV at the same time point.	22.6 ± 6.2^a a p < 0.01 vs. the VCV group at the same time point. ,^b b p < 0.01 vs. T1 in each group.
Compliance (mL. cm^-1 H₂O)	VCV	42.6 ± 6.5	18.8 ± 3.8^b b p < 0.01 vs. T1 in each group.	20.6 ± 5.1^b b p < 0.01 vs. T1 in each group.	17.8 ± 4.4^b b p < 0.01 vs. T1 in each group.
RR (breath. min^-1)	PCV-VG	11.3 ± 1.0	11.5 ± 0.8	12.3 ± 1.3	12.9 ± 2.4
RR (breath. min^-1)	VCV	11.3 ± 1.0	11.6 ± 1.0	12.4 ± 1.5^b b p < 0.01 vs. T1 in each group.	13.6 ± 2.9^b b p < 0.01 vs. T1 in each group.
TVe (mL)	PCV-VG	457.3 ± 39.0	470.1 ± 26.3^c c p < 0.05 vs. the VCV at the same time point.	469.7 ± 30.1^c c p < 0.05 vs. the VCV at the same time point. ^,f	472.3 ± 24.3^c c p < 0.05 vs. the VCV at the same time point. ,^d d p < 0.05 vs. T1 in each group.
TVe (mL)	VCV	448.9 ± 38.5	451.3 ± 42.6	452.73 ± 39.1	452.3 ± 50.8
etCO₂ (mmHg)	PCV-VG	35.28 ± 2.3	34.90 ± 2.3	37.66 ± 2.1^b b p < 0.01 vs. T1 in each group.	37.40 ± 1.9^b b p < 0.01 vs. T1 in each group. ,^c c p < 0.05 vs. the VCV at the same time point.
etCO₂ (mmHg)	VCV	35.18 ± 2.0	35.12 ± 2.0	38.40 ± 2.2^b b p < 0.01 vs. T1 in each group.	38.5 ± 2.4^b b p < 0.01 vs. T1 in each group.

		T1	T2	T3	T4
PaO₂ (mmHg)	PCV-VG	180.3 ± 30.3	176.3 ± 23.5^a a p < 0.05 vs. the VCV at the same time point.	165.5 ± 20.3^a a p < 0.05 vs. the VCV at the same time point. ,^b b p < 0.01 vs. T1 in each group.	165.2 ± 23.5^b b p < 0.01 vs. T1 in each group. ,^c c p < 0.01 vs. the VCV group at the same time point.
PaO₂ (mmHg)	VCV	180.7 ± 51.5	163.7 ± 24.9	155.9 ± 24.6^b b p < 0.01 vs. T1 in each group.	149.4 ± 27^b b p < 0.01 vs. T1 in each group.
PaCO₂ (mmHg)	PCV-VG	36.7 ± 3.1	36.4 ± 3.6	39.4 ± 3.3^b b p < 0.01 vs. T1 in each group.	39.9 ± 4^b b p < 0.01 vs. T1 in each group.
PaCO₂ (mmHg)	VCV	37.2 ± 2.5	36.6 ± 3.2	39.5 ± 4.1^b b p < 0.01 vs. T1 in each group.	40.60 ± 5.2^b b p < 0.01 vs. T1 in each group.
pH	PCV-VG	7.5 ± 0.1	7.4 ± 0.1^b b p < 0.01 vs. T1 in each group.	7.4 ± 0.1^b b p < 0.01 vs. T1 in each group.	7.4 ± 0.1^b b p < 0.01 vs. T1 in each group.
pH	VCV	7.4 ± 0.1	7.4 ± 0.1^b b p < 0.01 vs. T1 in each group.	7.4 ± 0.6^b b p < 0.01 vs. T1 in each group.	7.3 ± 0.1^b b p < 0.01 vs. T1 in each group.
SaO₂	PCV-VG	99.5 ± 0.9	99.5 ± 0.7	99 ± 0.8^b b p < 0.01 vs. T1 in each group.	98.7 ± 1.2^b b p < 0.01 vs. T1 in each group.
SaO₂	VCV	99.5 ± 0.6	99.1 ± 1.1	98.7 ± 1.2^b b p < 0.01 vs. T1 in each group.	98.7 ± 1.3^b b p < 0.01 vs. T1 in each group.

		T1	T2	T3	T4
HR	PCV-VG	66.2 ± 2.3	62.2 ± 1.9^a a p < 0.01 versus T1 in each group.	75.7 ± 5.2^a a p < 0.01 versus T1 in each group.	74.2 ± 3.3^a a p < 0.01 versus T1 in each group.
HR	VCV	66.5 ± 2.4	62.4 ± 2.3^a a p < 0.01 versus T1 in each group.	75.9 ± 2.7^a a p < 0.01 versus T1 in each group.	74.9 ± 3.6^a a p < 0.01 versus T1 in each group.
MAP	PCV-VG	68 ± 2.6	75.3 ± 3.2^a a p < 0.01 versus T1 in each group.	78.6 ± 4.5^a a p < 0.01 versus T1 in each group.	82.7 ± 4^a a p < 0.01 versus T1 in each group.
MAP	VCV	67.7 ± 2.8	75.9 ± 3.1^a a p < 0.01 versus T1 in each group.	79.3 ± 11.5^a a p < 0.01 versus T1 in each group.	83.5 ± 4.5^a a p < 0.01 versus T1 in each group.

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[1] * Corresponding author. E-mail:meltoker@gmail.com (M.K. Toker).