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Randomized Controlled Trial
. 2024 Jul 8;19(1):425.
doi: 10.1186/s13019-024-02881-x.

Effect of flow-optimized pressure control ventilation-volume guaranteed (PCV-VG) on postoperative pulmonary complications: a consort study

Ting Ting Sun #  1 , Ke Xin Chen #  1 , Yong Tao  1 , Gong Wei Zhang  1 , Li Zeng  1 , Min Lin  1 , Jing Huang  1 , Yue Hu  2
Affiliations
Randomized Controlled Trial

Effect of flow-optimized pressure control ventilation-volume guaranteed (PCV-VG) on postoperative pulmonary complications: a consort study

Ting Ting Sun et al. J Cardiothorac Surg. .

Abstract

Background: Postoperative pulmonary complications (PPCs) after one-lung ventilation (OLV) significantly impact patient prognosis and quality of life.

Objective: To study the impact of an optimal inspiratory flow rate on PPCs in thoracic surgery patients.

Methods: One hundred eight elective thoracic surgery patients were randomly assigned to 2 groups in this consort study (control group: n = 53 with a fixed inspiratory expiratory ratio of 1:2; and experimental group [flow rate optimization group]: n = 55). Measurements of Ppeak, Pplat, PETCO2, lung dynamic compliance (Cdyn), respiratory rate, and oxygen concentration were obtained at the following specific time points: immediately after intubation (T0); immediately after starting OLV (T1); 30 min after OLV (T2); and 10 min after 2-lung ventilation (T4). The PaO2:FiO2 ratio was measured using blood gas analysis 30 min after initiating one-lung breathing (T2) and immediately when OLV ended (T3). The lung ultrasound score (LUS) was assessed following anesthesia and resuscitation (T5). The occurrence of atelectasis was documented immediately after the surgery. PPCs occurrences were noted 3 days after surgery.

Results: The treatment group had a significantly lower total prevalence of PPCs compared to the control group (3.64% vs. 16.98%; P = 0.022). There were no notable variations in peak airway pressure, airway plateau pressure, dynamic lung compliance, PETCO2, respiratory rate, and oxygen concentration between the two groups during intubation (T0). Dynamic lung compliance and the oxygenation index were significantly increased at T1, T2, and T4 (P < 0.05), whereas the CRP level and number of inflammatory cells decreased dramatically (P < 0.05).

Conclusion: Optimizing inspiratory flow rate and utilizing pressure control ventilation -volume guaranteed (PCV-VG) mode can decrease PPCs and enhance lung dynamic compliance in OLV patients.

Keywords: Inspiratory pressure rise time; One-lung ventilation; PCV-VG ventilation; Postoperative pulmonary complications; Thoracic surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

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Fig. 1
The study enrollment flow chart
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