Abstract
Dual-controlled ventilation (DCV) combines the advantages of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning for robot-assisted laparoscopic radical prostatectomy (RALRP) has negative effects on the respiratory system. We hypothesized that the use of autoflow as one type of DCV can reduce these effects during RALRP. Eighty patients undergoing RALRP were randomly assigned to receive VCV or DCV. Arterial oxygen tension (PaO2) as the primary outcome, respiratory and hemodynamic data, and postoperative fever rates were compared at four time points: 10 min after anesthesia induction (T1), 30 and 60 min after the initiation of CO2 pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after supine positioning (T4). There were no significant differences in PaO2 between the two groups. Mean peak airway pressure (Ppeak) was significantly lower in group DCV than in group VCV at T2 (mean difference, 5.0 cm H2O; adjusted p < 0.001) and T3 (mean difference, 3.9 cm H2O; adjusted p < 0.001). Postoperative fever occurring within the first 2 days after surgery was more common in group VCV (12%) than in group DCV (3%) (p = 0.022). Compared with VCV, DCV did not improve oxygenation during RALRP. However, DCV significantly decreased Ppeak without hemodynamic instability.
Highlights
Recent advances in technology have led to the availability of new ventilation modes combining the advantages of both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in several new anesthesia machines
Two patients from each group were withdrawn from the analysis because of high Ppeak and protocol violations; intra-abdominal pressure had to be reduced from 15 mmHg to 10 mmHg due to excessively elevated Ppeak, and errors occurred in the setting of FiO2 and tidal volume on the ventilator machine
dual-controlled ventilation (DCV) was associated with significantly decreased Ppeak without hemodynamic instability during CO2 pneumoperitoneum and Trendelenburg positioning in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP)
Summary
Recent advances in technology have led to the availability of new ventilation modes combining the advantages of both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in several new anesthesia machines. Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning are commonly used in combination to provide adequate surgical viewing and space during robot-assisted or laparoscopic abdominal surgeries. They are likely to produce significant and potentially negative physiological changes in various organ systems, including the respiratory system [4,5]. Resulting atelectasis can reduce arterial oxygenation, and higher peak and plateau inspiratory pressure may increase the risk of barotrauma [5,9,10]
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