Effect of PCV-VG ventilation on intraoperative respiratory mechanics and pulmonary function during prolonged robotic-assisted laparoscopic surgery in the Trendelenburg position

Abstract

Objective To investigate the effect of applying pressure-controlled ventalition and volume-guaranteed (PCV-VG) ventilation on intraoperative respiratory mechanics and pulmonary function in patients in the Trendelenburg position during robot-assisted laparoscopic surgery. Methods Seventy-six patients who underwent robotic-assisted laparoscopic Trendelenburg position from April 2021 to May 2022 at the Affiliated Hospital of Xuzhou Medical University were selected and divided into PCV-VG group (group P ) and VCV group (group V ) using the random number table method. Observed indexes: intraoperative respiratory mechanics parameters such as peak airway pressure (Ppeak ), plateau pressure (Pplat ), pulmonary dynamic compliance (Cdyn), airway resistance(Raw). Respiratory function parameters: SpO2 , PaO2 , PaCO2 , SaO2 and calculate the oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (PA-a DO2 ), intrapulmonary shunt (Qs /Qt ), respiratory index (RI); intraoperative hemodynamic index and postoperative complications. Results Compared with VCV, PCV-VG, a new ventilation mode, can better ensure the mechanical ventilation effect in patients with prolonged robotic head-down position without affecting hemodynamics, reduce peak airway pressure and plateau pressure, increase dynamic lung compliance, and optimize intraoperative respiratory function in pneumoperitoneum and Trendelenburg position patients with Trendelenburg position duration over 2h.Conclusion: Compared to VCV, PCV-VG provided lower Ppeak with Pplat and improved Cdyn during robot-assisted laparoscopic Trendelenburg position surgery, better pulmonary oxygenation and gas exchange after pneumoperitoneum duration beyond 2h,better quality of recovery at 24h postoperatively. while there was no significant difference in hemodynamic variables.