Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation - A randomized...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Respiratory Physiology

Background:

• One-lung ventilation (OLV) during thoracic surgery presents challenges in maintaining adequate gas exchange.
• Pressure-controlled ventilation (PCV) is the standard but may not optimize oxygenation or minimize lung injury.
• Flow-controlled ventilation (FCV) offers an alternative ventilation strategy.

Purpose of the Study:

• To compare the efficacy of flow-controlled ventilation (FCV) against pressure-controlled ventilation (PCV) in patients undergoing thoracic surgery requiring OLV.
• To evaluate the impact of FCV on oxygenation, carbon dioxide removal, and mechanical ventilation parameters.

Main Methods:

• A prospective, non-blinded, randomized controlled trial was conducted with patients scheduled for elective thoracic surgery.
• Participants were randomly assigned to receive either FCV or PCV throughout the anesthesia period.
• The primary endpoint was the paO2/FiO2 ratio 30 minutes after OLV initiation; secondary endpoints included minute volume for CO2 removal and applied mechanical power.

Main Results:

• The study included 43 patients, with 46 enrolled.
• FCV demonstrated a significantly higher paO2/FiO2 ratio (187 mmHg) compared to PCV (136 mmHg) (p=0.047).
• FCV required significantly lower minute volumes for CO2 removal (3.0 L/min vs 4.5 L/min, p<0.001) and applied significantly lower mechanical power (3.5 J/min vs 7.6 J/min, p<0.001).

Conclusions:

• Flow-controlled ventilation (FCV) significantly improves oxygenation and facilitates carbon dioxide removal during one-lung ventilation in thoracic surgery.
• FCV reduces the mechanical power delivered to the lungs, potentially mitigating ventilator-induced lung injury.
• This study supports FCV as a beneficial ventilation strategy in thoracic surgery settings.