Effect of pressure controlled volume guaranteed ventilation during pulmonary resection in children

Change Zhu,Yuting Zhang,Rufang Zhang,Shenghua Yu,Rong Wei

doi:10.1038/s41598-022-05693-y

Change Zhu, Yuting Zhang + Show 3 more

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https://doi.org/10.1038/s41598-022-05693-y

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Journal: Scientific Reports	Publication Date: Feb 10, 2022
Citations: 2	License type: open-access

Affiliation: Shanghai Children's Hospital

Abstract

The purpose of the study was to evaluate the effect of pressure controlled volume guaranteed ventilation in children requiring one lung ventilation during pulmonary resection. Patients were randomly assigned to the lung protective ventilation combined with pressure controlled volume guaranteed group (PCV-VG group) or the lung protective ventilation combined with volume controlled ventilation group (VCV group). Both groups received tidal-volume ventilation of 8 ml kg−1 body weight during two lung ventilation and 6 ml kg−1 during OLV, with sustained 5 cmH2O positive end-expiratory pressure. Data collections were mainly performed at 10 min after induction of anaesthesia during TLV (T1), 5 min after OLV initiation (T2) and 5 min after complete CO2 insufflations (T3). In total, 63 patients were randomly assigned to the VCV (n = 31) and PCV-VG (n = 32) groups. The PCV-VG group exhibited lower PIP than the VCV group at T1 (16.8 ± 2.3 vs. 18.7 ± 2.7 cmH2O, P = 0.001), T2 (20.2 ± 2.7 vs. 22.4 ± 3.3 cmH2O, P = 0.001), and T3 (23.8 ± 3.2 vs. 26.36 ± 3.7 cmH2O, P = 0.01). Static compliance was higher in the PCV-VG group at T1, T2, and T3 (P = 0.01). After anaesthesia induction, lung aeration deteriorated, but with no immediate postoperative difference in both groups. Postoperative lung aeration improved and returned to normal from 2.5 h postextubation in both groups. PH was lower and PaCO2 was higher in VCV group than PCV-VG group during one lung ventilation. No differences were observed in PaO2-FiO2-ratio at T2 and T3, the incidence of postoperative pulmonary complications, intraoperative desaturation and the length of hospital stay. In paediatric patients, who underwent pulmonary resection requiring one lung ventilation, PCV-VG was superior to VCV in its ability to provide lower PIP, higher static compliance and lower PaCO2 at one lung ventilation during pneumothorax. However, its beneficial effects on different pathological situations in pediatric patients need more investigation.

Highlights

The purpose of the study was to evaluate the effect of pressure controlled volume guaranteed ventilation in children requiring one lung ventilation during pulmonary resection
For the comparison of Peak inspiratory pressure (PIP) between the groups, the results of repeated measures ANOVA revealed PIP at T2 and T3 were lower in the PCV-VG group than in the volume controlled ventilation (VCV) group (T2, 20.2 ± 2.7 cmH2O vs 22.4 ± 3.3 cmH2O; P = 0.001) (T3, 23.8 ± 3.2 cmH2O vs 26.36 ± 3.7 cmH2O; P = 0.01) (Fig. 2)
The heart rate was stable throughout the operation (Fig. 5). This randomised controlled trial revealed that PCV-VG was superior to VCV in its ability to provide ventilation with lower PIP, lower PaCO2 and higher static compliance and PH during one lung ventilation

Summary

Introduction

The purpose of the study was to evaluate the effect of pressure controlled volume guaranteed ventilation in children requiring one lung ventilation during pulmonary resection. In paediatric patients, who underwent pulmonary resection requiring one lung ventilation, PCV-VG was superior to VCV in its ability to provide lower PIP, higher static compliance and lower PaCO2 at one lung ventilation during pneumothorax. Several studies involving adults have demonstrated that PCV-VG potentially reduces airway pressure and improves lung compliance compared to volume controlled ventilation (VCV)[6,7,8]; the anatomical and physiological characteristics of children differ from adults. Whether children benefit from PCV-VG is unclear and relevant studies are lacking On this premise, this study aimed to compare PCV-VG with VCV in terms of airway pressure, static compliance, PaO2-FiO2-ratio, PaCO2, arterial pH, lung aeration in lung ultrasound, postoperative pulmonary complications, intraoperative desaturation, hospital stay, and haemodynamics in children requiring OLV

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