• J. Cardiothorac. Vasc. Anesth. · Oct 2017

    Randomized Controlled Trial Comparative Study

    Comparison Between Pressure-Regulated Volume-Controlled and Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures, and Immune Modulation During Thoracic Surgery.

    • Khaled Mahmoud, Amany Ammar, and Zeinab Kasemy.
    • Minoufiya Faculty of Medicine, Minoufiya University, Shebin Elkoam, Egypt. Electronic address: mahmoudk16@yahoo.com.
    • J. Cardiothorac. Vasc. Anesth. 2017 Oct 1; 31 (5): 1760-1766.

    ObjectivesTo compare 2 different ventilatory strategies: pressure-regulated volume-controlled (PRVC) versus volume-controlled ventilation during thoracotomy.DesignProspective randomized study.SettingUniversity hospital.ParticipantsThe study comprised 70 adult patients undergoing thoracic surgery.InterventionsEvaluation of oxygenation parameters, airway pressures, and immune modulation.Measurements And Main ResultsThe primary outcome was arterial oxygen tension/fraction of inspired oxygen (PaO2/FIO2) ratio, whereas secondary outcomes included arterial and central venous blood gases, deadspace volume/tidal volume ratio, peak inspiratory pressure, mean inspiratory pressure, and plateau inspiratory pressure obtained at the following 4 time points: 20 minutes after total lung ventilation (T0), 20 minutes after 1-lung ventilation (T1), 20 minutes after return to total lung ventilation (T2), and at the end of surgery (T3). Furthermore, alveolar and plasma levels of interleukin-8 and tumor necrosis factor-α and changes in alveolar albumin levels and cell numbers were measured at the same time points. Oxygenation parameters (PaO2/FIO2 and PaO2) were significantly better in the PRVC group (PaO2/FIO2 ratio at T1 was 176 v 146 in the PRVC and volume-controlled groups, respectively, with a p value of 0.004). Deadspace volume/tidal volume ratio and inspiratory airway pressures were significantly lower in the PRVC group. Furthermore, all inflammatory parameters (alveolar and plasma interleukins, alveolar albumin levels, and cell numbers) were significantly lower in the PRVC group.ConclusionsThe PRVC mode during 1-lung ventilation in thoracic surgery caused a favorable effect on oxygenation parameters, respiratory mechanics, and immune modulation during thoracic surgery.Copyright © 2017 Elsevier Inc. All rights reserved.

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