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Randomized Controlled Trial
. 2023 Nov 20;23(1):379.
doi: 10.1186/s12871-023-02343-2.

Pressure-controlled ventilation-volume guaranteed mode improves bronchial mucus transport velocity in patients during laparoscopic surgery for gynecological oncology: a randomized controlled study

Chao Deng  1   2 , Tao Xu  3 , Xue-Kai Wang  1 , Deng-Feng Gu  1
Affiliations
Randomized Controlled Trial

Pressure-controlled ventilation-volume guaranteed mode improves bronchial mucus transport velocity in patients during laparoscopic surgery for gynecological oncology: a randomized controlled study

Chao Deng et al. BMC Anesthesiol. .

Abstract

Background: Mechanical ventilation during general anesthesia may impair airway mucosal function. This study aimed to investigate the effect of pressure-controlled ventilation-volume guaranteed (PCV-VG) on bronchial mucus transport velocity (BTV) in patients during laparoscopic surgery for gynecological oncology compared with volume controlled ventilation (VCV).

Methods: 66 patients undergoing elective a laparoscopic surgery for gynecological oncology. The patients were randomized into two group receiving either PCV-VG or VCV. a drop of methylene blue was placed on the surface of the airway mucosa under the bronchoscopeand, then the distance the dye movement was measured after 2, 4, and 6 min. Outcomes were assessed at T0 (5 min after endotracheal intubation and before initiation of pneumoperitoneum), T1 and T2 (1 and 2 h after stabilization of pneumoperitoneum respectively). BTV at T0, T1 and T2 was the primary outcome. Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), body temperature, end-tidal CO2 pressure (PETCO2), tidal volume(VT), peak inspiratory pressure (PIP), mean inspiratory pressure (Pmean), respiratory rate (RR), and dynamic compliance (CDyn) at T0, T1, and T2.

Results: 64 patients were included in the analysis. The median [interquartile range] BTV was significantly lower in VCV group at T1 and T2 that at T0 (P < 0.05). Furthermore, BTV was slightly reduced in PCV-VG compared with VCV. BTV in PCV-VG was significantly decreased at T2 compared with BTV at T0 (P < 0.05) and slightly decreased at T1 compared with T0(P > 0.05). Compared with the PCV-VG group, BTV in VCV group significantly decreased at T2 (P < 0.05). No participants experienced respiratory complications.

Conclusions: PCV-VG is more suitable for patients undergoing laparoscopic surgery for gynecological oncology than VCV since it can protect mucociliary clearance function.

Trial registration: This trial is registered on https://www.chictr.org.cn/ in Chinese Clinical Trial Registry (ChiCTR.2200064564: Date of registration 11/10/2022).

Keywords: Airway mucosa; Bronchial mucus transport velocity; Gynecological oncology; Laparoscopic surgery; Pressure-controlled ventilation-volume guaranteed; Volume-controlled ventilation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Method for measuring bronchial mucus transport velocity (BTV). a An epidural catheter is inserted through a biopsy hole. b The catheter extends from the distal end of the biopsy hole. c Epidural catheter reaches the junction of the left upper bronchial opening and left lower bronchial opening. d Inject methylene blue dye. e Mark the zero point. f Methylene blue motion trajectory. g The catheter moves to the near edge of the dye's trajectory. h Mark the mark point. i Measure the distance between the mark point and the zero position
Fig. 2
Fig. 2
Consort diagram for patient recruitment in the trial
Fig. 3
Fig. 3
Boxplots of BTV in T0, T1 and T2 for VCV, and PCV-VG group. The solid horizontal lines indicate the medians, the boxes extend to the IQR, the whiskers extend to the maximum and minimum values of BTV T0 = Immediately after endotracheal intubation, hemodynamics and mechanical ventilation were stable; T1 = 1 h after pneumoperitoneum; T2 = 2 h after pneumoperitoneum; BTV = bronchial mucus transport velocity; IQR = interquartile range; ns: p > 0.05, *p < 0.05, **p < 0.01, ***p < 0.001
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