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Postoperative Hypoxemia After Dual-Controlled vs Volume-Controlled Ventilation in Lung Surgery
Andres Zorrilla-Vaca1, Michael C Grant2, Muhammad Rehman1
1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
The Annals of Thoracic Surgery
|January 7, 2023
Summary
Dual-controlled ventilation did not improve pulmonary outcomes in lung resection surgery compared to conventional methods. Low tidal volumes were associated with reduced hypoxemia, regardless of ventilator mode.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Respiratory Physiology
Background:
- One-lung ventilation during thoracic surgery poses risks of hypoxemia and barotrauma.
- Dual-controlled ventilation, such as pressure-regulated volume control (PRVC), may offer better lung mechanics than conventional volume-controlled ventilation (VCV).
Purpose of the Study:
- To investigate the association between ventilatory mode (PRVC vs. VCV) and pulmonary outcomes following lung resection surgery.
Main Methods:
- A historical cohort study (2016-2021) compared PRVC and VCV groups.
- Propensity score matching created 774 pairs based on preoperative and intraoperative factors.
- Primary outcome was postoperative hypoxemia; secondary outcomes included respiratory complications.
Main Results:
- No significant difference in postoperative hypoxemia (33.3% PRVC vs. 37.7% VCV; aOR 0.93) or pulmonary complications (3.9% PRVC vs. 3.4% VCV; aOR 0.96) between groups.
- Lower tidal volumes (≤6 mL/kg IBW) were linked to reduced hypoxemia (aOR 0.73).
Conclusions:
- Pressure-regulated volume control ventilation was not associated with improved pulmonary outcomes compared to volume-controlled ventilation in lung resection surgery.
- Tidal volume management appears more critical for preventing hypoxemia than the choice of ventilatory mode.
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