Comparison of Pressure- and Volume-Controlled Ventilation in Laparoscopic Surgery: A Meta-analysis of Randomized Controlled Trial

Abstract

Purpose: Volume-controlled ventilation (VCV) has been the traditional mechanical ventilation mode in laparoscopic surgery. Pressure-controlled ventilation (PCV) has been used more frequently in recent years, especially for patients with complicated conditions; however, evidence on whether PCV is superior to VCV is still lacking. A meta-analysis was used to compare the effects of PCV and VCV on respiratory and hemodynamic parameters during laparoscopic surgery. Methods: PubMed and Embase were each searched from their inception to December 2014 for randomized controlled trials comparing the effects of PCV and VCV on respiratory and hemodynamic parameters during laparoscopic surgery. Standard mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effect model. Outcomes were assessed at three times: preoperative (T1), intraoperative (T2) and postoperative (T3). Respiratory mechanics (including peak airway pressure, plateau pressure, mean airway pressure, compliance, airway resistance, minute volume, end-tidal CO2 tension and tidal volume) and hemodynamic parameters (including heart rate and mean arterial pressure) were calculated. Results: Eight randomized controlled trials with a total of 428 participants, 214 cases using PCV and 214 cases using VCV, were included in the meta-analysis. No significant differences were detected between the groups in terms of hemodynamic parameters. In contrast, with respiratory mechanics, PCV was slightly but significantly associated with lower peak airway pressure, higher compliance, lower airway resistance at T1, lower peak airway pressure, higher compliance, higher mean airway pressure at T2, lower peak airway pressure, lower mean airway pressure and higher end-tidal CO2 tension at T3. For the rest of respiratory parameters, there were no statistical differences between the groups. Subgroup analysis by morbidly obese, type of operations and quality of studies, showed similar results. Conclusions: Our meta-analysis suggests that hemodynamic parameters are similar in patients who underwent laparoscopic surgery with PCV and VCV, but patients who had PCV exhibited mildly better respiratory data.

Comparison of pressure vs. volume controlled ventilation on oxygenation parameters of obese patients undergoing laparoscopic cholecystectomy

“…Subgroup analysis showed the same results with the morbid obese patients. 18 Jiang et al in another meta-analysis compared PCV and VCV in 1643 patients in different positions (supine, lateral and prone)and conditions (one lung ventilation and laparoscopy) and showed that VCV is associated with decreased oxygenation index and increased alveolar-arterial oxygen difference. Subgroup analysis showed the same results during laparoscopy in obese patients.…”

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

“…Out of the eight enrolled RCTs, only three included laparoscopic pelvic surgeries which require steep Trendelenburg position that further compromises the respiratory mechanics altered after pneumoperitoneum. [ 8 ] Jiang et al . also recently conducted a meta-analysis of 27 trials with 1643 cases to compare PCV and VCV modes on different positions (supine, prone and lateral) and conditions (laparoscopic surgery, one lung ventilation, etc.).…”

Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position

“…The meta-analysis that compared PCV and VCV modes during laparoscopic surgery by Wang et al ( 2015 ) concluded that patients had PCV mode had lower P-peak and resistance accompanying higher compliance and P-mean levels. Although with subgroup analysis revealed the same results including morbid obese patients who underwent different kind of operations.…”

“…Pressure-controlled ventilation (PCV), with its high and decelerating inspiratory flow, has faster tidal volume delivery and different gas distribution. The same tidal volume setting, delivered by PCV versus VCV, may result in a lower peak airway pressure and reduced risk of barotrauma, but variable tidal and minute volume may be generated (Campbell and Davis 2002 ; Wang et al 2015 ; Jiang et al 2016 ).…”