Adaptive support ventilation for gynaecological laparoscopic surgery in Trendelenburg position: bringing ICU modes of mechanical ventilation to the operating room

Llorens, J.; Ballester, Mayte; Tusman, Gerardo; Blasco, L.; García-Fernández, Javier; Jover, José Luis de Miguel; Belda, F. Javier

doi:10.1097/eja.0b013e32831aed42

Cited by 15 publications

(6 citation statements)

References 23 publications

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“…These benefits of pressure limited approach could be achieved with other pressure targeted mode like Pressure Regulated Volume Control (PRVC) and Adaptive Support Ventilation (ASV), future research in this field is required so that pressure limited approach of ventilation can become the standard of care for patients undergoing laparoscopic surgeries in Trendelenburg position. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

Jaju

Dubey

et al. 2017

Indian J Anaesth

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Background and Aims:Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV) has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position.Methods:This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30), where VCV mode was maintained through anaesthesia, or the PCV group (n = 30), where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis) and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure) were measured at baseline (T1), post-Trendelenburg position at 60 min (T2), 120 min (T3) and after resuming supine position (T4).Results:Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV) were comparable between two groups. Despite similar values of APmean, APpeak was significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001). Cdyn and PaCO2 were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively).Conclusion:PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdyn and a better-preserved ventilation-perfusion matching for the same levels of MV.

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Section: Discussionmentioning

confidence: 99%

Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

Jaju

Dubey

et al. 2017

Indian J Anaesth

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“…found that only changing the inspiratory pressures and the ratio of inspiratory time to total time without much changing the minute ventilation was enough to compensate the changing lung mechanics during gynecological laparoscopy. [15]…”

Section: Discussionmentioning

confidence: 99%

Pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy

Sinha

Chiplonkar

Ghanshani

2012

J Anaesthesiol Clin Pharmacol

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Background:It is well documented that pressure-controlled ventilation (PCV) improves oxygenation and ventilation compared to volume-controlled ventilation and reduces peak airway pressure in gynecological laparoscopy. PCV with moderately inversed inspiratory–expiratory (I: E) ratio can successfully recruit collapsed alveoli and has been proved to be beneficial in intensive care. We tested the hypothesis that altering the I: E ratio to 1.5:1 in PCV improves ventilation during gynecological laparoscopy using laryngeal mask airway (LMA).Objective:To study pressure-controlled inverse ratio ventilation (PCIRV) with I: E ratio 1.5:1 as against PCV with I: E ratio 1:2 in gynecological laparoscopy with LMA using noninvasive parameters.Materials and Methods:Intraoperative hemodynamics and side-stream spirometry recordings were noted in 20 consecutive patients undergoing major gynecological laparoscopy with LMA. Flexible LMA or LMA supreme were used depending on normal body mass index (BMI) or high BMI, respectively.Results:Reversing the I: E ratio to 1.5:1 increased the tidal volume, mean airway pressures, and dynamic lung compliance significantly, all indicating better oxygenation at comparable peak airway pressures as against PCV with I: E ratio 1:2. There was no change in the end-tidal carbon dioxide. There was no auto-positive end expiratory pressure (PEEP) or change in the hemodynamics.Conclusion:Reversal of I: E ratio with PCV can be beneficially used with LMA in laparoscopy.

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“…The degree of Trendelenburg is adjusted and should be maintained at a position where the bowel is just about to descend towards the pelvis over the pelvic brim. A prospective study of 22 patients undergoing gynaecological laparoscopic procedures in whom the Trendelenburg was maintained between 30 and 50 and the pneumoperitoneum between 12 and 15 mmHg demonstrated a reduction of 44.4% in the compliance of the respiratory system and an increase in expiratory airway resistances of 29.1% [19].…”

Section: Exposure Techniques and Patient Positioningmentioning

confidence: 99%

Obesity in laparoscopic surgery

Afors

Centini

Murtada

et al. 2015

Best Practice & Research Clinical Obstetrics & Gynaecol

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Adaptive support ventilation for gynaecological laparoscopic surgery in Trendelenburg position: bringing ICU modes of mechanical ventilation to the operating room

Abstract: In healthy women undergoing gynaecologic laparoscopy, ASV automatically adapted the ventilatory settings to the changes in the respiratory mechanics, keeping constant the preset minute ventilation, providing an adequate exchange of respiratory gases and obviating clinician's interventions.

Cited by 15 publications

References 23 publications

Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial

Pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy

Obesity in laparoscopic surgery

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