Comparison between volume-controlled and pressure-controlled ventilation in COPD patients undergoing laparoscopic cholecystectomy

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a well-known independent risk factor for the development of postoperative pulmonary complications. Managing ventilation and oxygenation during laparoscopic cholecystectomy (with creation of pneumoperitoneum) in these patients presents many challenges. Aim of this study: was to compare between volume-controlled and pressure-controlled ventilation in COPD patients undergoing laparoscopic cholecystectomy. Methods: A case control study was conducted on 60 participants aged between 18 and 60 years, diagnosed with COPD and scheduled for laparoscopic cholecystectomy. To start with, all patients received volume-controlled ventilation (VCV). Fifteen minutes after creation of pneumoperitoneum, they were randomized to receive either VCV (Group A) or pressure-controlled ventilation; PCV (Group B). Hemodynamics, ventilatory parameters, arterial blood gas analyses were noted. All data were analyzed statistically. Results: There was no significant difference between study groups as regards hemodynamic variables. Peak airway pressure was significantly lower in PCV group compared with VCV group. Mean airway pressure was significantly higher in PCV group compared with VCV group. As regards arterial blood gas analyses, there was no significant difference between study groups as regards PaO2 and SpO2. Patients in PCV group had higher PaCO2 (yet not clinically significant) at 35 min, compared with patients in VCV group. Conclusion: PCV and VCV were generally effective in maintaining adequate ventilation, oxygenation and hemodynamic stability. Peak airway pressure was significantly lower in PCV group compared with VCV group, thus decreasing the risk of barotrauma. PCV may be a better choice than VCV in COPD patients undergoing laparoscopic cholecystectomy.