Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery

Abstract

Background: The appropriate ventilation mode for one-lung ventilation (OLV) in infants undergoing video-assisted thoracoscopic surgery (VATS) remains controversial. Here we investigated the effect of ventilatory mode "pressure-controlled ventilation-volume guaranteed" (PCV-VG) on the airway pressures and oxygenation parameters by comparing it with volume-controlled ventilation (VCV). Methods:We retrospectively analyzed the clinical data of infants aged 2 to 12 months who underwent extratracheal bronchial blockage for OLV in our center between January 2017 and August 2020. The infants were divided into two groups according to the OLV pattern: group G (n=30, receiving PCV-VG) and group V (n=28, receiving VCV). Mean arterial pressure (MAP), heart rate (HR), maximum inspiratory pressure (P peak ), mean airway pressure (P mean ), dynamic compliance (Cdyn), partial arterial pressure of oxygen (PaO 2 ) was measured and compared between these two groups 10 min before OLV (T1), 30 min after the onset of OLV (T2) and 15 min after OLV (T3). The possible occurrence of hypoxemia and hypotension during OLV was monitored.Results: Compared to group V, group G had significantly higher PaO 2 and C dyn (both P<0.05) and significantly lower P peak and P mean (both P<0.05) in T2. However, all indicators did not show significant differences between these two groups at T1 and T3 (all P>0.05). The incidence of hypoxemia was significantly higher in group V than in group G (P<0.05), while the difference in the incidence of hypotension was not statistically significant (P>0.05).Conclusions: Mechanical ventilation using the PCV-VG mode is possible in infants when performing OLV during VATS. Compared to VCV, PCV-VG can offer lower P peak and P mean , improve lung compliance, and achieve better oxygenation.

PCV‐VG combined individualized PEEP determination in one‐lung ventilated patients with PEEP step change direction: A randomized controlled trial

“…PCV reduces airway pressure and decelerates airflow, but may cause lung injury by exerting traction on the alveoli 16 . However, PCV‐VG combines the advantages of VCV and PCV, which allows the use of decelerated airflow in the volume‐controlled mode and simultaneously ensures V T airflow declaration, reducing airway and alveolar damage from high airway pressures, and protecting the lungs in various fields 17 . OLV is usually used in thoracic surgery to isolate bilateral lungs and prevent secretions, infection sources, blood, or tumors from one lung from entering the other, thus protecting the healthy lungs.…”

“… 16 However, PCV‐VG combines the advantages of VCV and PCV, which allows the use of decelerated airflow in the volume‐controlled mode and simultaneously ensures V T airflow declaration, reducing airway and alveolar damage from high airway pressures, and protecting the lungs in various fields. 17 OLV is usually used in thoracic surgery to isolate bilateral lungs and prevent secretions, infection sources, blood, or tumors from one lung from entering the other, thus protecting the healthy lungs. One‐lung anesthesia is required for lung and thoracic surgeries to provide clear vision, shorten the operating time, and reduce unnecessary tissue damage.…”

Effect of different mechanical ventilation modes on cerebral blood flow during thoracoscopic surgery in neonates: A randomised controlled trial

“…PCV-VG was associated with a lower incidence of hypoxaemia and better oxygenation. [ 22 ] A meta-analysis reported significantly lower peak inspiratory pressures in PCV-VG than in VCV in adults undergoing OLV. [ 23 ] Older studies showed better arterial oxygenation with PCV than VCV during OLV.…”