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Effect of pressure controlled volume guaranteed ventilation during pulmonary resection in children
Change Zhu1, Rufang Zhang2, Shenghua Yu1
1Department of Anesthesiology, Shanghai Children's Hospital, Shanghai, China.
Insights
Pressure controlled volume guaranteed ventilation (PCV-VG) offers better outcomes than volume controlled ventilation (VCV) in pediatric patients undergoing pulmonary resection. PCV-VG reduces peak inspiratory pressure and improves lung compliance during one lung ventilation.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Mechanics
- Thoracic Surgery
Background:
- One lung ventilation (OLV) is crucial during pulmonary resections but presents challenges in pediatric patients.
- Optimizing ventilation strategies is essential to minimize lung injury and improve outcomes in this population.
Purpose of the Study:
- To compare the efficacy of pressure controlled volume guaranteed (PCV-VG) ventilation versus volume controlled ventilation (VCV) in pediatric patients undergoing pulmonary resection requiring OLV.
Main Methods:
- Sixty-three pediatric patients were randomized to either PCV-VG or VCV groups, both receiving lung protective ventilation.
- Ventilation parameters, including peak inspiratory pressure (PIP), static compliance, and blood gas analysis, were recorded during two lung ventilation and OLV.
- Data were collected at specific time points: after anesthesia induction, upon OLV initiation, and after CO2 insufflation.
Main Results:
- The PCV-VG group demonstrated significantly lower PIP and higher static compliance compared to the VCV group during OLV.
- PCV-VG also resulted in lower PaCO2 levels during OLV.
- No significant differences were observed in oxygenation (PaO2-FiO2 ratio), postoperative complications, intraoperative desaturation, or hospital stay between the groups.
Conclusions:
- PCV-VG is superior to VCV in managing pediatric patients during OLV for pulmonary resection, offering improved respiratory mechanics.
- Further research is needed to explore the broader benefits of PCV-VG across various pediatric pathological conditions.
- PCV-VG facilitates better control of ventilation and gas exchange during challenging thoracic surgical procedures in children.
Abstract:
The purpose of the study was to evaluate the effect of pressure controlled volume guaranteed ventilation in children requiring one lung ventilation during pulmonary resection. Patients were randomly assigned to the lung protective ventilation combined with pressure controlled volume guaranteed group (PCV-VG group) or the lung protective ventilation combined with volume controlled ventilation group (VCV group). Both groups received tidal-volume ventilation of 8 ml kg-1 body weight during two lung ventilation and 6 ml kg-1 during OLV, with sustained 5 cmH2O positive end-expiratory pressure. Data collections were mainly performed at 10 min after induction of anaesthesia during TLV (T1), 5 min after OLV initiation (T2) and 5 min after complete CO2 insufflations (T3). In total, 63 patients were randomly assigned to the VCV (n = 31) and PCV-VG (n = 32) groups. The PCV-VG group exhibited lower PIP than the VCV group at T1 (16.8 ± 2.3 vs. 18.7 ± 2.7 cmH2O, P = 0.001), T2 (20.2 ± 2.7 vs. 22.4 ± 3.3 cmH2O, P = 0.001), and T3 (23.8 ± 3.2 vs. 26.36 ± 3.7 cmH2O, P = 0.01). Static compliance was higher in the PCV-VG group at T1, T2, and T3 (P = 0.01). After anaesthesia induction, lung aeration deteriorated, but with no immediate postoperative difference in both groups. Postoperative lung aeration improved and returned to normal from 2.5 h postextubation in both groups. PH was lower and PaCO2 was higher in VCV group than PCV-VG group during one lung ventilation. No differences were observed in PaO2-FiO2-ratio at T2 and T3, the incidence of postoperative pulmonary complications, intraoperative desaturation and the length of hospital stay. In paediatric patients, who underwent pulmonary resection requiring one lung ventilation, PCV-VG was superior to VCV in its ability to provide lower PIP, higher static compliance and lower PaCO2 at one lung ventilation during pneumothorax. However, its beneficial effects on different pathological situations in pediatric patients need more investigation.
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