Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients

Abstract

Background:The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. Methods: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). Results: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m 2 in group 1 patients and 3.8±0.8 L/min/m 2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m 2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. Conclusions: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions.

Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

“…These complications encompassed arrhythmias, hypotension, and myocardial ischemia, necessitating supplemental interventions like inotropic support and anti-arrhythmic medications. This disparity could be partially attributed to the hemodynamic impact of the two ventilation modes[ 32 , 33 ]. Interestingly, In comparison to VCV, PCV has been reported to exert more favorable effects on cardiac output, arterial blood pressure, and venous return[ 34 ].…”

Importance of Anesthesia in Pediatric Laparoscopic Procedures

“…It is crucial to calculate VT based on ideal rather than actual body weight. Currently, there is no unmistakable evidence to support the benefits of any specific mode of ventilation [19].…”