Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: a randomized controlled trial

Móntes, Félix; Pardo, Daniel; Charris, Hernán; Téllez, Luis Jaime; Garzón, Juan Carlos; Osorio, Camilo

doi:10.1186/1749-8090-5-99

Cited by 32 publications

(27 citation statements)

References 27 publications

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“…However, others have reported that PCV results in poorer oxygenation [20, 21] and the effect of PCV on oxygenation is one of the areasof greatest controversy. We hypothesized that PCV is associated with improved oxygenation and lower inspiratory pressure in comparison with VCV.…”

Section: Introductionmentioning

confidence: 99%

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Kim

Jeong

et al. 2015

BMC Anesthesiol

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BackgroundNot only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively.MethodsWe searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. A meta-analysis of randomized controlled trials was performed using the Cochrane Review Methods.ResultsSix studies (259 participants) were included. The PaO2/FiO2 ratio in PCV was higher than in VCV [weighted mean difference (WMD) = 11.04 mmHg, 95 % confidence interval (CI) = 0.30 to 21.77, P = 0.04, I2 = 3 %] and peak inspiratory pressure was significantly lower in PCV (WMD = −4.91 cm H2O, 95 % CI = −7.30 to –2.53, P < 0.0001, I 2 = 91 %). No differences in PaCO2, tidal volume, heart rate and blood pressure were observed. There were also no differences incompliance, plateau and mean airway pressure.ConclusionsOur meta-analysis provided the evidence of improved oxygenation in PCV. However, it is difficult to draw any definitive conclusions due to the fact that the duration of ventilation in the studies reviewed was insufficient to reveal clinically relevant benefits or disadvantages of PCV. Significantly lower peak inspiratory pressure is the advantage of PCV.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0238-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Kim

Jeong

et al. 2015

BMC Anesthesiol

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“…During PCV the clinician should titrate the inspiratory pressure to the measured tidal volume, but the inspiratory flow and flow waveform are determined by the ventilator as it attempts to maintain a square inspiratory pressure profile (18). Thus, advantage of PCV is a lower peak airway pressure, but disadvantage is that tidal volume delivery increases and decreases with changes of patient's compliance (18,19).…”

Section: Discussionmentioning

confidence: 99%

Ventilator „Chirana Aura V“ In Two Models Of Neonatal Acute Lung Injury - A Pilot Study

Tomclkova¹,

Mokrá²,

Plstekova³

et al. 2014

Acta Medica Martiniana

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A b s t r a c tIn severe respiratory insufficiency, neonatal and pediatric patients should be ventilated artificially by a ventilator. Aim of this experimental study was to evaluate whether the newly developed ventilator Chirana Aura V may effectively ventilate the lungs of animals with two different models of acute lung injury: acute respiratory distress syndrome (ARDS) induced by repetitive saline lavage and meconium aspiration syndrome (MAS) induced by intratracheal instillation of neonatal meconium.The experiments were performed on 10 adult rabbits (New Zealand white). In ARDS group (n=5), the lungs were repetitively lavaged with saline (30 ml/kg) until partial pressure of oxygen (PaO 2 ) in arterial blood was under 26.7 kPa at inspiratory fraction of oxygen FiO 2 =1.0. In MAS group (n=5), animals were instilled 4 ml/kg of suspension of human meconium (25 mg/ml). When the model of acute lung injury was developed, animals were ventilated for additional 2 hours with pressure control ventilation (PCV) regime by ventilator Chirana Aura V. Ventilatory parameters, blood gases, acid-base balance, end-tidal CO 2 , O 2 saturation of hemoglobin, oxygenation indexes, ventilation efficiency index, dynamic lung compliance, and right-to-left pulmonary shunts were measured and calculated in regular time intervals. In both experimental groups, used ventilatory settings provided acceptable gas exchange within the period of observation. Thus, the results indicate that ventilator Chirana Aura V might be suitable for ventilation of animal models of acute lung injury. However, further pre-clinical investigation is needed before its use may be recommended in neonatal and/or pediatric patients with acute lung injury.

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“…Methodologically, as primary graft dysfunction grades 3 and 4 are synonymous with ALI and acute respiratory distress syndrome (ARDS), our study was based on the protective ventilation concept adapted from the literature . A comparison between volume and pressure‐controlled ventilation was included due to previous studies demonstrating that lower peak pressures may minimise acute lung injury . Similar to Montes et al ,.…”

Section: Discussionmentioning

confidence: 99%

Intra‐operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial

et al. 2017

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Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml.kg , one-lung ventilation 4 ml.kg )) or an alveolar recruitment group (regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16 cmH O with 10 cmH O positive end-expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO /F O ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end-point was the PaO /F O ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean (SD) PaO /F O ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean (SD) PaO /F O ratios at the end of the surgical procedure and a longer median (IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10-27 [5-468]) h vs. 15 (11-36 [5-115]) h (p = 0.01), respectively). An open-lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.

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Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: a randomized controlled trial

Cited by 32 publications

References 27 publications

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Ventilator „Chirana Aura V“ In Two Models Of Neonatal Acute Lung Injury - A Pilot Study

Intra‐operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial

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