Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis

Abstract

For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.

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

“…To ensure the delivery of a preset tidal volume to the lungs of a pediatric patient, the PCV-VG mode automatically adjusts the air delivery rate and the airway pressure level according to reduced lung compliance, resulting in a prolonged inspiratory phase and the lowest P peak ; it is adjusted to the expiratory mode after the target tidal volume is reached. A meta-analysis found significantly lower P peak (P<0.00001) in the PCV-VG group than in the VCV group in adults undergoing OLV (17).…”

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

“…Modern ventilation mode of PCV-VG is known as dual-controlled ventilation mode that manufacturer is GE healthcare, similarly, manufacturer of “pressure-regulated volume control ventilation” is Maquet, and volume mode with “auto-flow” ventilation is Dräger. 9 Despites the advantages of dual-controlled ventilation that delivering target volume with the lowest possible pressure, there has not been established consensus of the mode of mechanical ventilation reducing PPCs. 23 Some of previous studies have reported findings consistent with those in the present study, 10 11 12 13 14 while others have reported different results.…”

“…Recent technology has suggested new modes of ventilation, using pressure-controlled ventilation, with digital feedback mechanism of controlling preset V T with the lowest possible pressure, which is called pressure-controlled ventilation volume-guaranteed (PCV-VG). 9 Volume-controlled ventilation (VCV), on the other hand, could be an achieved variation of airway pressure, despite being a popular positive-pressure ventilation mode during general anesthesia (GA) in terms of advantages of ensuring accurate target volume. 9 …”

“… 9 Volume-controlled ventilation (VCV), on the other hand, could be an achieved variation of airway pressure, despite being a popular positive-pressure ventilation mode during general anesthesia (GA) in terms of advantages of ensuring accurate target volume. 9 …”

Understanding pediatric ventilation in the operative setting. Part II: Setting perioperative ventilation

“…2 Modes of comparable functionality are also available for perioperative ventilation with modern AWS. Whereas evidence in regard to improved respiratory mechanics is quite convincing in adults undergoing elective surgery, 3 the evidence is less good developed for ventilation during pediatric anesthesia.…”