Abdullah M Al Shehri1, Mohamed R El-Tahan2, Roshdi Al Metwally3, Hatem Qutub4, Yasser F El Ghoneimy5, Mohamed A Regal5, Haytham Zien3. 1. Department of Cardiology, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia. 2. Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia. Electronic address: mohamedrefaateltahan@yahoo.com. 3. Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia. 4. Department of Pulmonology and Intensive Care Unit, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia. 5. Cardiothoracic Surgery, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Abstract
OBJECTIVES: To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. DESIGN: A prospective, randomized, double-blind, controlled, crossover study. SETTING: A single university hospital. PARTICIPANTS: Fourteen pairs of consecutive patients scheduled for elective thoracotomy. INTERVENTIONS: Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. MEASUREMENTS AND MAIN RESULTS: Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation indices were similar during the use of VCV and PCV. CONCLUSIONS: The use of PCV offers more improved RV function than the use of VCV during OLV for open thoracotomy. These results apply specifically to younger patients with good ventricular and pulmonary functions.
RCT Entities:
OBJECTIVES: To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function. DESIGN: A prospective, randomized, double-blind, controlled, crossover study. SETTING: A single university hospital. PARTICIPANTS: Fourteen pairs of consecutive patients scheduled for elective thoracotomy. INTERVENTIONS:Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia. MEASUREMENTS AND MAIN RESULTS: Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation indices were similar during the use of VCV and PCV. CONCLUSIONS: The use of PCV offers more improved RV function than the use of VCV during OLV for open thoracotomy. These results apply specifically to younger patients with good ventricular and pulmonary functions.
Authors: Young Sung Kim; Young Ju Won; Dong Kyu Lee; Byung Gun Lim; Heezoo Kim; Il Ok Lee; Jin Hee Yun; Myoung Hoon Kong Journal: Clin Interv Aging Date: 2019-07-18 Impact factor: 4.458