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Caljé-van der Klei T, Sun Q, Chase JG, Zhou C, Tawhai MH, Knopp JL, Möller K, Heines SJ, Bergmans DC, Shaw GM. Pulmonary response prediction through personalized basis functions in a virtual patient model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107988. [PMID: 38171168 DOI: 10.1016/j.cmpb.2023.107988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Recruitment maneuvers with subsequent positive-end-expiratory-pressure (PEEP) have proven effective in recruiting lung volume and preventing alveoli collapse. However, determining a safe, effective, and patient-specific PEEP is not standardized, and this more optimal PEEP level evolves with patient condition, requiring personalised monitoring and care approaches to maintain optimal ventilation settings. METHODS This research examines 3 physiologically relevant basis function sets (exponential, parabolic, cumulative) to enable better prediction of elastance evolution for a virtual patient or digital twin model of MV lung mechanics, including novel elements to model and predict distension elastance. Prediction accuracy and robustness are validated against recruitment maneuver data from 18 volume-controlled ventilation (VCV) patients at 7 different baseline PEEP levels (0 to 12 cmH2O) and 14 pressure-controlled ventilation (PCV) patients at 4 different baseline PEEP levels (6 to 12 cmH2O), yielding 623 and 294 prediction cases, respectively. Predictions were made up to 12 cmH2O of added PEEP ahead, covering 6 × 2 cmH2O PEEP steps. RESULTS The 3 basis function sets yield median absolute peak inspiratory pressure (PIP) prediction error of 1.63 cmH2O for VCV patients, and median peak inspiratory volume (PIV) prediction error of 0.028 L for PCV patients. The exponential basis function set yields a better trade-off of overall performance across VCV and PCV prediction than parabolic and cumulative basis function sets from other studies. Comparing predicted and clinically measured distension prediction in VCV demonstrated consistent, robust high accuracy with R2 = 0.90-0.95. CONCLUSIONS The results demonstrate recruitment mechanics are best captured by an exponential basis function across different mechanical ventilation modes, matching physiological expectations, and accurately capture, for the first time, distension mechanics to within 5-10 % accuracy. Enabling the risk of lung injury to be predicted before changing ventilator settings. The overall outcomes significantly extend and more fully validate this digital twin or virtual mechanical ventilation patient model.
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Affiliation(s)
- Trudy Caljé-van der Klei
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand.
| | - Qianhui Sun
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand; University of Liége, Liége, Belgium
| | - J Geoffrey Chase
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - Cong Zhou
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - Merryn H Tawhai
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Jennifer L Knopp
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Christchurch, New Zealand
| | - Knut Möller
- Institute for Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Serge J Heines
- Department of Intensive Care, School of Medicine, Maastricht University, Maastricht, Netherlands
| | - Dennis C Bergmans
- Department of Intensive Care, School of Medicine, Maastricht University, Maastricht, Netherlands
| | - Geoffrey M Shaw
- Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand
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Bhar D, Chowdhury S, Maiti A, Chattopadhyay S. Volume-controlled, pressure-controlled vs. pressure-controlled volume-guaranteed ventilations in improving respiratory dynamics during laparoscopic cholecystectomy: A prospective, randomized, comparative study. BALI JOURNAL OF ANESTHESIOLOGY 2023. [DOI: 10.4103/bjoa.bjoa_254_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Li XF, Jin L, Yang JM, Luo QS, Liu HM, Yu H. Effect of ventilation mode on postoperative pulmonary complications following lung resection surgery: a randomised controlled trial. Anaesthesia 2022; 77:1219-1227. [PMID: 36066107 DOI: 10.1111/anae.15848] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
The effect of intra-operative mechanical ventilation modes on pulmonary outcomes after thoracic surgery with one-lung ventilation has not been well established. We evaluated the impact of three common ventilation modes on postoperative pulmonary complications in patients undergoing lung resection surgery. In this two-centre randomised controlled trial, 1224 adults scheduled for lung resection surgery with one-lung ventilation were randomised to one of three groups: volume-controlled ventilation; pressure-controlled ventilation; and pressure-control with volume guaranteed ventilation. Enhanced recovery after surgery pathways and lung-protective ventilation protocols were implemented in all groups. The primary outcome was a composite of postoperative pulmonary complications within the first seven postoperative days. The outcome occurred in 270 (22%), with 87 (21%) in the volume control group, 89 (22%) in the pressure control group and 94 (23%) in the pressure-control with volume guaranteed group (p = 0.831). The secondary outcomes also did not differ across study groups. In patients undergoing lung resection surgery with one-lung ventilation, the choice of ventilation mode did not influence the risk of developing postoperative pulmonary complications. This is the first randomised controlled trial examining the effect of three ventilation modes on pulmonary outcomes in patients undergoing lung resection surgery.
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Affiliation(s)
- X-F Li
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - L Jin
- Department of Anaesthesiology, Leshan People's Hospital, Leshan, China
| | - J-M Yang
- Department of Anaesthesiology, Leshan People's Hospital, Leshan, China
| | - Q-S Luo
- Department of Anaesthesiology, Leshan People's Hospital, Leshan, China
| | - H-M Liu
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - H Yu
- Department of Anaesthesiology, West China Hospital of Sichuan University, Chengdu, China
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Avilés-Rojas N, Hurtado DE. Whole-lung finite-element models for mechanical ventilation and respiratory research applications. Front Physiol 2022; 13:984286. [PMID: 36267590 PMCID: PMC9577367 DOI: 10.3389/fphys.2022.984286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Mechanical ventilation has been a vital treatment for Covid-19 patients with respiratory failure. Lungs assisted with mechanical ventilators present a wide variability in their response that strongly depends on air-tissue interactions, which motivates the creation of simulation tools to enhance the design of ventilatory protocols. In this work, we aim to create anatomical computational models of the lungs that predict clinically-relevant respiratory variables. To this end, we formulate a continuum poromechanical framework that seamlessly accounts for the air-tissue interaction in the lung parenchyma. Based on this formulation, we construct anatomical finite-element models of the human lungs from computed-tomography images. We simulate the 3D response of lungs connected to mechanical ventilation, from which we recover physiological parameters of high clinical relevance. In particular, we provide a framework to estimate respiratory-system compliance and resistance from continuum lung dynamic simulations. We further study our computational framework in the simulation of the supersyringe method to construct pressure-volume curves. In addition, we run these simulations using several state-of-the-art lung tissue models to understand how the choice of constitutive models impacts the whole-organ mechanical response. We show that the proposed lung model predicts physiological variables, such as airway pressure, flow and volume, that capture many distinctive features observed in mechanical ventilation and the supersyringe method. We further conclude that some constitutive lung tissue models may not adequately capture the physiological behavior of lungs, as measured in terms of lung respiratory-system compliance. Our findings constitute a proof of concept that finite-element poromechanical models of the lungs can be predictive of clinically-relevant variables in respiratory medicine.
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Affiliation(s)
- Nibaldo Avilés-Rojas
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Daniel E. Hurtado,
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LaChance J, Schottdorf M, Zajdel TJ, Saunders JL, Dvali S, Marshall C, Seirup L, Sammour I, Chatburn RL, Notterman DA, Cohen DJ. PVP1-The People's Ventilator Project: A fully open, low-cost, pressure-controlled ventilator research platform compatible with adult and pediatric uses. PLoS One 2022; 17:e0266810. [PMID: 35544461 PMCID: PMC9094548 DOI: 10.1371/journal.pone.0266810] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Mechanical ventilators are safety-critical devices that help patients breathe, commonly found in hospital intensive care units (ICUs)-yet, the high costs and proprietary nature of commercial ventilators inhibit their use as an educational and research platform. We present a fully open ventilator device-The People's Ventilator: PVP1-with complete hardware and software documentation including detailed build instructions and a DIY cost of $1,700 USD. We validate PVP1 against both key performance criteria specified in the U.S. Food and Drug Administration's Emergency Use Authorization for Ventilators, and in a pediatric context against a state-of-the-art commercial ventilator. Notably, PVP1 performs well over a wide range of test conditions and performance stability is demonstrated for a minimum of 75,000 breath cycles over three days with an adult mechanical test lung. As an open project, PVP1 can enable future educational, academic, and clinical developments in the ventilator space.
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Affiliation(s)
- Julienne LaChance
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, New Jersey, United States of America
| | - Manuel Schottdorf
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, United States of America
| | - Tom J. Zajdel
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Jonny L. Saunders
- Department of Psychology and Institute of Neuroscience, University of Oregon, Eugene, Oregon, United States of America
| | - Sophie Dvali
- Department of Physics, Princeton University, Princeton, New Jersey, United States of America
| | - Chase Marshall
- RailPod, Inc., Boston, Massachusetts, United States of America
| | - Lorenzo Seirup
- New York ISO, Rensselaer, New York, United States of America
| | - Ibrahim Sammour
- Department of Neonatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America
| | - Robert L. Chatburn
- Department of Neonatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States of America
| | - Daniel A. Notterman
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Daniel J. Cohen
- Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, New Jersey, United States of America
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Goodwin AJ, Eytan D, Greer RW, Mazwi M, Thommandram A, Goodfellow SD, Assadi A, Jegatheeswaran A, Laussen PC. A practical approach to storage and retrieval of high-frequency physiological signals. Physiol Meas 2020; 41:035008. [PMID: 32131060 DOI: 10.1088/1361-6579/ab7cb5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Storage of physiological waveform data for retrospective analysis presents significant challenges. Resultant data can be very large, and therefore becomes expensive to store and complicated to manage. Traditional database approaches are not appropriate for large scale storage of physiological waveforms. Our goal was to apply modern time series compression and indexing techniques to the problem of physiological waveform storage and retrieval. APPROACH We deployed a vendor-agnostic data collection system and developed domain-specific compression approaches that allowed long term storage of physiological waveform data and other associated clinical and medical device data. The database (called AtriumDB) also facilitates rapid retrieval of retrospective data for high-performance computing and machine learning applications. MAIN RESULTS A prototype system has been recording data in a 42-bed pediatric critical care unit at The Hospital for Sick Children in Toronto, Ontario since February 2016. As of December 2019, the database contains over 720,000 patient-hours of data collected from over 5300 patients, all with complete waveform capture. One year of full resolution physiological waveform storage from this 42-bed unit can be losslessly compressed and stored in less than 300 GB of disk space. Retrospective data can be delivered to analytical applications at a rate of up to 50 million time-value pairs per second. SIGNIFICANCE Stored data are not pre-processed or filtered. Having access to a large retrospective dataset with realistic artefacts lends itself to the process of anomaly discovery and understanding. Retrospective data can be replayed to simulate a realistic streaming data environment where analytical tools can be rapidly tested at scale.
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Affiliation(s)
- Andrew J Goodwin
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. School of Biomedical Engineering, University of Sydney, Sydney, New South Wales, Australia
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7
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Souza Leite W, Novaes A, Bandeira M, Olympia Ribeiro E, dos Santos AM, de Moura PH, Morais CC, Rattes C, Richtrmoc MK, Souza J, Correia de Lima GH, Pinheiro Modolo NS, Gonçalves ACE, Ramirez Gonzalez CA, do Amparo Andrade M, Dornelas De Andrade A, Cunha Brandão D, Lima Campos S. Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial. Multidiscip Respir Med 2020; 15:650. [PMID: 32373344 PMCID: PMC7196928 DOI: 10.4081/mrm.2020.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND AIM Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. METHODS A prospective parallel randomised trialin the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. RESULTS All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n=9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. CONCLUSIONS There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.
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Affiliation(s)
- Wagner Souza Leite
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Alita Novaes
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Monique Bandeira
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Pedro Henrique de Moura
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Caio César Morais
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Catarina Rattes
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Juliana Souza
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Norma Sueli Pinheiro Modolo
- Department of Anaesthesiology, Institute of Bioscience, School of Medicine, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | | | - Maria do Amparo Andrade
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Daniella Cunha Brandão
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Shirley Lima Campos
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Effect of Endotracheal Tube Size, Respiratory System Mechanics, and Ventilator Settings on Driving Pressure. Pediatr Crit Care Med 2020; 21:e47-e51. [PMID: 31688716 DOI: 10.1097/pcc.0000000000002186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to investigate factors that affect the difference between the peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions (resistive pressure) during pressure controlled ventilation across a range of endotracheal tube sizes, respiratory mechanics, and ventilator settings. DESIGN In vitro study. SETTING Research laboratory. PATIENTS None. INTERVENTIONS An in vitro bench model of the intubated respiratory system during pressure controlled ventilation was used to obtain the difference between peak inspiratory pressure measured at the Y-piece under dynamic flow conditions and plateau pressure measured under zero-flow conditions across a range of endotracheal tubes sizes (3.0-8.0 mm). Measurements were taken at combinations of pressure above positive end-expiratory pressure (10, 15, and 20 cm H2O), airway resistance (no, low, high), respiratory system compliance (ranging from normal to extremely severe), and inspiratory time at constant positive end-expiratory pressure (5 cm H2O). Multiple regression analysis was used to construct models predicting resistive pressure stratified by endotracheal tube size. MEASUREMENTS AND MAIN RESULTS On univariate regression analysis, respiratory system compliance (β -1.5; 95% CI, -1.7 to -1.4; p < 0.001), respiratory system resistance (β 1.7; 95% CI, 1.5-2.0; p < 0.001), pressure above positive end-expiratory pressure (β 1.7; 95% CI, 1.4-2.0; p < 0.001), and inspiratory time (β -0.7; 95% CI, -1.0 to -0.4; p < 0.001) were associated with resistive pressure. Multiple linear regression analysis showed the independent association between increasing respiratory system compliance, increasing airway resistance, increasing pressure above positive end-expiratory pressure, and decreasing inspiratory time and resistive pressure across all endotracheal tube sizes. Inspiratory time was the strongest variable associated with a proportional increase in resistive pressure. The contribution of airway resistance became more prominent with increasing endotracheal tube size. CONCLUSIONS Peak inspiratory pressures measured during pressure controlled ventilation overestimated plateau pressure irrespective of endotracheal tube size, especially with decreased inspiratory time or increased airway resistance.
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Lee JM, Lee SK, Rhim CC, Seo KH, Han M, Kim SY, Park EY. Comparison of volume-controlled, pressure-controlled, and pressure-controlled volume-guaranteed ventilation during robot-assisted laparoscopic gynecologic surgery in the Trendelenburg position. Int J Med Sci 2020; 17:2728-2734. [PMID: 33162800 PMCID: PMC7645327 DOI: 10.7150/ijms.49253] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/12/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Pressure-controlled ventilation volume-guaranteed (PCV-VG) is being increasingly used for ventilation during general anesthesia. Carbon dioxide (CO2) pneumoperitoneum in the Trendelenburg position is routinely used during robot-assisted laparoscopic gynecologic surgery. Here, we hypothesized that PCV-VG would reduce peak inspiratory pressure (Ppeak), compared to volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Methods: In total, 60 patients were enrolled in this study and randomly assigned to receive VCV, PCV, or PCV-VG. Hemodynamic variables, respiratory variables, and arterial blood gases were measured in the supine position 15 minutes after the induction of anesthesia (T0), 30 and 60 minutes after CO2 pneumoperitoneum and Trendelenburg positioning (T1 and T2, respectively), and 15 minutes after placement in the supine position at the end of anesthesia (T3). Results: The Ppeak was higher in the VCV group than in the PCV and PCV-VG groups (p=0.011). Mean inspiratory pressure (Pmean) was higher in the PCV and PCV-VG groups than in the VCV group (p<0.001). Dynamic lung compliance (Cdyn) was lower in the VCV group than in the PCV and PCV-VG groups (p=0.001). Conclusion: Compared to VCV, PCV and PCV-VG provided lower Ppeak, higher Pmean, and improved Cdyn, without significant differences in hemodynamic variables or arterial blood gas results during robot-assisted laparoscopic gynecologic surgery with Trendelenburg position.
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Affiliation(s)
- Jung Min Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Chae Chun Rhim
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Kwon Hui Seo
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Minsu Han
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - So Youn Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Republic of Korea
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Gallagher JJ. Alternative Modes of Mechanical Ventilation. AACN Adv Crit Care 2019; 29:396-404. [PMID: 30523010 DOI: 10.4037/aacnacc2018372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes. Alternative modes of ventilation are tools for lung protection, alveolar recruitment, and ventilator liberation. Understanding the function and application of these alternative modes prior to implementation is essential and is most beneficial for the patient.
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Affiliation(s)
- John J Gallagher
- John J. Gallagher is Trauma Program Manager/Clinical Nurse Specialist at Penn Presbyterian Medical Center, 51 N 39th Street, Medical Office Building, Suite 120, Philadelphia, PA 19104
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11
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Kothari A, Baskaran D. Pressure-controlled Volume Guaranteed Mode Improves Respiratory Dynamics during Laparoscopic Cholecystectomy: A Comparison with Conventional Modes. Anesth Essays Res 2018; 12:206-212. [PMID: 29628583 PMCID: PMC5872865 DOI: 10.4103/aer.aer_96_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Pneumoperitoneum and altered positioning 1in laparoscopic cholecystectomy predispose to alterations in cardiorespiratory physiology. We compared the effects of volume controlled, pressure controlled, and the newly introduced pressure controlled-volume guaranteed ventilation (PCV-VG) modes of ventilation on respiratory mechanics and oxygenation during laparoscopic cholecystectomy. Materials and Methods: Seventy-five physical status American Society of Anesthesiologists Classes I and II patients with normal lungs undergoing laparoscopic cholecystectomy were randomly allocated to receive volume controlled ventilation (VCV), pressure-controlled ventilation (PCV), or PCV-VG modes of ventilation during general anesthesia. In all modes of ventilation, the tidal volume was set at 8 mL/kg, and respiratory rate was set at 12 breaths/min with inspired oxygen of 0.4. After pneumoperitoneum, respiratory rate was adjusted to maintain an end-tidal carbon dioxide between 32 and 37 mm Hg. The peak airway pressures, compliance, the mean airway pressures, oxygen saturation, end tidal carbon dioxide and hemodynamics were recorded at the time of intubation (T1), 15 min after pneumoperitoneum (T2) and after desufflation (T3) and were compared. Arterial oxygen tension, arterial carbon dioxide tension at T2 and T3 were compared. Results: PCV-VG and PCV mode resulted in lower peak airway pressures than VCV (23.04 ± 3.43, 24.52 ± 2.79, and 27.24 ± 2.37 cm of water, respectively, P = 0.001). Compliance was better preserved in the pressure mediated modes than VCV (fall from baseline was 42%, 29%, and 30% in VCV, PCV, and PCV-VG). The arterial to end-tidal carbon dioxide gradient was lower in PCV-VG and PCV compared to VCV. No difference in oxygenation and hemodynamics were observed. Conclusion: PCV and PCV-VG modes are superior to VCV mode in providing adequate oxygenation at lower peak inspiratory pressures.
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Affiliation(s)
- Apoorwa Kothari
- Department of Anaesthesia and Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Deepa Baskaran
- Department of Anaesthesia and Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Mahmoud K, Ammar A, Kasemy Z. Comparison Between Pressure-Regulated Volume-Controlled and Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures, and Immune Modulation During Thoracic Surgery. J Cardiothorac Vasc Anesth 2017; 31:1760-1766. [DOI: 10.1053/j.jvca.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 11/11/2022]
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13
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Zhu YQ, Fang F, Ling XM, Huang J, Cang J. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy. J Thorac Dis 2017; 9:1303-1309. [PMID: 28616282 DOI: 10.21037/jtd.2017.04.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is controversial as to which ventilation mode is better during one-lung ventilation (OLV). This study was designed to figure out whether there was any difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) on oxygenation and postoperative complications under the condition of protective ventilation (PV). METHODS Sixty-five patients undergoing video-assisted thoracoscopic lobectomy were randomized into two groups. Patients in group V received VCV mode during OLV while patients in group P received PCV. The tidal volume (VT) in both groups was 6 mL per predicted body weight (PBW). Positive end-expiratory pressure (PEEP) was set at the level of 5 cmH2O in both groups. Arterial gas analysis were performed preoperatively with room air (T0), at 15 mins (T1) and 1 h (T2) after OLV, at the end of OLV (T3), 30 min after PACU admission (T4), 24 h after surgery (post-operative day 1, POD1) and 48 h after surgery (post-operative day 2, POD2). Peak inspiratory airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at T1, T2 and T3. The perioperative complications were also recorded. RESULT Sixty-four patients completed this study. Ppeak in group V was significantly higher than that in group P (T1 22.3±2.9 vs. 18.7±2.1 cmH2O; T2 22.2±2.8 vs. 18.7±2.6 cmH2O). There were no differences with Pplat and intraoperative oxygenation index (T1 203.3±109.7 vs. 198.1±93.4; T2 216.8±79.1 vs. 232.1±101.4). The postoperative oxygenation index (T4 525.0±160.9 vs. 520.7±127.1, post-operative day 1 (POD1) 452.1±161.3 vs. 446.1±109.1; post-operative day 2 (POD2) 403.8±93.4 vs. 396.7±92.8) and postoperative complications were also comparable between these two groups. CONCLUSIONS When they were utilized during OLV, PCV and VCV had the same performance on the intraoperative oxygenation and postoperative complications under the condition of PV.
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Affiliation(s)
- Yi-Qi Zhu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fang Fang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Min Ling
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian Huang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Moningi S, Elmati PK, Rao P, Kanithi G, Kulkarni DK, Ramachandran G. Comparison of volume control and pressure control ventilation in patients undergoing single level anterior cervical discectomy and fusion surgery. Indian J Anaesth 2017; 61:818-825. [PMID: 29242654 PMCID: PMC5664887 DOI: 10.4103/ija.ija_605_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: Pressure control and volume control ventilation are the most preferred modes of ventilator techniques available in the intraoperative period. The study compared the intraoperative ventilator and blood gas variables of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in patients undergoing single level anterior cervical discectomy and fusion (ACDF). Methods: After obtaining Institutional Ethical Committee approval and informed consent, sixty patients scheduled for single level ACDF surgery performed in supine position under general anaesthesia were included. Group V (30 patients) received VCV and Group P (30 patients) received PCV. The primary objective was oxygenation variable PaO2/FiO2 at different points of time i.e. T1–20 min after the institution of the ventilation, T2–20 min after placement of the retractors and T3–20 min after removal of the retractors. The secondary objectives include other arterial blood gas parameters, respiratory and haemodynamic parameters. NCSS version 9 statistical software was used for statistics. Two-way repeated measures for analysis of variance with post hoc Tukey Kramer test was used to analyse continuous variables for both intra- and inter-group comparisons, paired sample t-test for overall comparison and Chi-square test for categorical data. Results: The primary variable PaO2/FiO2 was comparable in both groups (P = 0.08). The respiratory variables, PAP and Cdynam were statistically significant in PCV group compared to VCV (P < 0.05), though clinically insignificant. Other secondary variables were comparable. (P > 0.05) Conclusion: Clinically, both PCV and VCV group appear to be-equally suited ventilator techniques for anterior cervical spine surgery patients.
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Affiliation(s)
- Srilata Moningi
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Praveen Kumar Elmati
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Prasad Rao
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Geetha Kanithi
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Dilip Kumar Kulkarni
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gopinath Ramachandran
- Department of Anaesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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15
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Jaju R, Jaju PB, Dubey M, Mohammad S, Bhargava AK. Comparison of volume controlled ventilation and pressure controlled ventilation in patients undergoing robot-assisted pelvic surgeries: An open-label trial. Indian J Anaesth 2017; 61:17-23. [PMID: 28216699 PMCID: PMC5296801 DOI: 10.4103/0019-5049.198406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV) has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position. Methods: This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30), where VCV mode was maintained through anaesthesia, or the PCV group (n = 30), where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis) and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure) were measured at baseline (T1), post-Trendelenburg position at 60 min (T2), 120 min (T3) and after resuming supine position (T4). Results: Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV) were comparable between two groups. Despite similar values of APmean, APpeak was significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001). Cdyn and PaCO2 were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively). Conclusion: PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdyn and a better-preserved ventilation-perfusion matching for the same levels of MV.
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Affiliation(s)
- Rishabh Jaju
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Pooja Bihani Jaju
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mamta Dubey
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sadik Mohammad
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - A K Bhargava
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Kim KN, Kim DW, Jeong MA, Sin YH, Lee SK. Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis. BMC Anesthesiol 2016; 16:72. [PMID: 27581657 PMCID: PMC5007729 DOI: 10.1186/s12871-016-0238-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively. METHODS We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. A meta-analysis of randomized controlled trials was performed using the Cochrane Review Methods. RESULTS Six studies (259 participants) were included. The PaO2/FiO2 ratio in PCV was higher than in VCV [weighted mean difference (WMD) = 11.04 mmHg, 95 % confidence interval (CI) = 0.30 to 21.77, P = 0.04, I(2) = 3 %] and peak inspiratory pressure was significantly lower in PCV (WMD = -4.91 cm H2O, 95 % CI = -7.30 to -2.53, P < 0.0001, I (2) = 91 %). No differences in PaCO2, tidal volume, heart rate and blood pressure were observed. There were also no differences incompliance, plateau and mean airway pressure. CONCLUSIONS Our meta-analysis provided the evidence of improved oxygenation in PCV. However, it is difficult to draw any definitive conclusions due to the fact that the duration of ventilation in the studies reviewed was insufficient to reveal clinically relevant benefits or disadvantages of PCV. Significantly lower peak inspiratory pressure is the advantage of PCV.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
| | - Dong Won Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea.
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
| | - Yeong Hun Sin
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, 222, Wangsimni-ro, Seongdonggu, Seoul, 133-792, Republic of Korea
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17
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Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery. J Clin Monit Comput 2016; 31:75-84. [PMID: 26992377 DOI: 10.1007/s10877-016-9824-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/03/2016] [Indexed: 12/20/2022]
Abstract
Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO2/FiO2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.
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18
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Liao CC, Kau YC, Ting PC, Tsai SC, Wang CJ. The Effects of Volume-Controlled and Pressure-Controlled Ventilation on Lung Mechanics, Oxidative Stress, and Recovery in Gynecologic Laparoscopic Surgery. J Minim Invasive Gynecol 2016; 23:410-7. [PMID: 26772778 DOI: 10.1016/j.jmig.2015.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To compare ventilation variables, changes in oxidative stress, and the quality of recovery in 2 different ventilation strategies (volume-controlled ventilation [VCV] and pressure-controlled ventilation [PCV]) during gynecologic laparoscopic surgery. DESIGN A prospective randomized controlled trial (Canadian Task Force classification I). SETTING One university teaching hospital in Taiwan. PATIENTS Women scheduled for laparoscopic gynecologic surgery. INTERVENTIONS Women were randomly assigned to receive either VCV or PCV during surgery. MEASUREMENTS AND MAIN RESULTS Ventilation variables were recorded 1 minute before and 1 hour after pneumoperitoneum. Blood samples were collected for malondialdehyde measurement at 7 points: 1 minute before and 1 hour after pneumoperitoneum; 30, 60, 90, and 120 minutes after deflation; and 24 hours after surgery. Postoperative recovery was assessed by using a 9-item quality of recovery score at 24 hours after surgery. A total of 52 women randomly allocated to the VCV (n = 27) or PCV (n = 25) group completed the study. We found that after 1 hour of insufflation the PCV group had lower peak airway pressure (22.0 ± 3.4 vs 26.6 ± 4.1 cm H2O, p < .0001) and higher compliance (28.4 ± 3.7 vs 24.1 ± 3.3 mL/cm H2O, p < .0001) than the VCV group. In plasma levels of malondialdehyde, there were no significant differences between the 2 groups at 7 time points. The levels significantly increased in both groups after 1 hour of pneumoperitoneum and peaked at 2 hours after deflation. During postoperative recovery, lower scores were obtained at 24 hours after surgery compared with preoperative scores, but there were no significant differences between the 2 groups. CONCLUSION PCV is an alternative ventilation mode in gynecologic laparoscopic surgery. However, PCV offered lower peak airway pressure and higher compliance than VCV but no advantages over VCV in oxidative stress or quality of recovery.
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Affiliation(s)
- Chia-Chih Liao
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Yi-Chuan Kau
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Shih-Chang Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan.
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19
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Rittayamai N, Katsios CM, Beloncle F, Friedrich JO, Mancebo J, Brochard L. Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure: A Physiology-Based Narrative and Systematic Review. Chest 2015; 148:340-355. [PMID: 25927671 DOI: 10.1378/chest.14-3169] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mechanical ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes. METHODS We performed a systematic review and meta-analysis to determine whether pressure control-continuous mandatory ventilation (PC-CMV) or pressure control-inverse ratio ventilation (PC-IRV) has demonstrated advantages over volume control-continuous mandatory ventilation (VC-CMV). The Cochrane tool for risk of bias was used for methodologic quality. We also introduced physiologic criteria as quality indicators for selecting the studies. Outcomes included compliance, gas exchange, hemodynamics, work of breathing, and clinical outcomes. Analyses were completed with RevMan5 using random effects models. RESULTS Thirty-four studies met inclusion criteria, many being at high risk of bias. Comparisons of PC-CMV/PC-IRV and VC-CMV did not show any difference for compliance or gas exchange, even when looking at PC-IRV. Calculating the oxygenation index suggested a poorer effect for PC-IRV. There was no difference between modes in terms of hemodynamics, work of breathing, or clinical outcomes. CONCLUSIONS The two modes have different working principles but clinical available data do not suggest any difference in the outcomes. We included all identified trials, enhancing generalizability, and attempted to include only sufficient quality physiologic studies. However, included trials were small and varied considerably in quality. These data should help to open the choice of ventilation of patients with acute respiratory failure.
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Affiliation(s)
- Nuttapol Rittayamai
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Christina M Katsios
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - François Beloncle
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Medical Intensive Care Unit, Hospital of Angers, Université d'Angers, Angers, France
| | - Jan O Friedrich
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital Sant Pau, Barcelona, Spain
| | - Laurent Brochard
- Li Ka Shing Knowledge Institute and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada.
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Using ABGs to optimize mechanical ventilation: three case studies illustrate how arterial blood gas analyses can guide appropriate ventilator strategy. Dimens Crit Care Nurs 2014; 32:204-9. [PMID: 23759918 DOI: 10.1097/dcc.0b013e31829d3c10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article focuses on translating arterial blood gas information into clinical benefits, with 3 case scenarios that focus on using arterial blood gases to manage mechanical ventilation.
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21
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Using ABGs to optimize mechanical ventilation. Nursing 2013; 43:46-52; quiz 52-3. [PMID: 23619379 DOI: 10.1097/01.nurse.0000423964.08400.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Gupta SD, Kundu SB, Ghose T, Maji S, Mitra K, Mukherjee M, Mandal S, Sarbapalli D, Bhattacharya S, Bhattacharya S. A comparison between volume-controlled ventilation and pressure-controlled ventilation in providing better oxygenation in obese patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 2012; 56:276-82. [PMID: 22923828 PMCID: PMC3425289 DOI: 10.4103/0019-5049.98777] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The maintenance of oxygenation is a commonly encountered problem in obese patients undergoing laparoscopic cholecystectomy. There is no specific guideline on the ventilation modes for this group of patients. Although several studies have been performed to determine the optimal ventilatory settings in these patients, the answer is yet to be found. The aim of this study was to evaluate the efficacy of pressure-controlled ventilation (PCV) in comparison with volume-controlled ventilation (VCV) for maintaining oxygenation during laparoscopic cholecystectomy in obese patients. Methods: One hundred and two adult patients of ASA physical status I and II, Body Mass Index of 30–40 kg/m2, scheduled for laparoscopic cholecystectomy were included in this prospective randomized open-label parallel group study. To start with, all patients received VCV. Fifteen minutes after creation of pneumoperitoneum, they were randomized to receive either VCV (Group V) or PCV (Group P). The ventilatory parameters were adjusted accordingly to maintain the end-tidal CO2 between 35 and 40 mmHg. Respiratory rate, tidal volume, minute ventilation and peak airway pressure were noted. Arterial blood gas analyses were done 15 min after creation of pneumoperitoneum and at 20-min intervals thereafter till the end of the surgery. All data were analysed statistically. Results: Patients in Group P showed a statistically significant (P < 0.05) higher level of PaO2 and lower value of PAO2–PaO2 than those in Group V. Conclusion: PCV is a more effective mode of ventilation in comparison with VCV regarding oxygenation in obese patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Sampa Dutta Gupta
- Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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23
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Dresse C, Joris JL, Hans GA. Mechanical ventilation during anaesthesia: Pathophysiology and clinical implications. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Karcz M, Vitkus A, Papadakos PJ, Schwaiberger D, Lachmann B. State-of-the-art mechanical ventilation. J Cardiothorac Vasc Anesth 2011; 26:486-506. [PMID: 21601477 DOI: 10.1053/j.jvca.2011.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Marcin Karcz
- Department of Anesthesiology, University of Rochester, Rochester, NY 14642, USA.
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25
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Tyagi A, Kumar R, Sethi AK, Mohta M. A comparison of pressure-controlled and volume-controlled ventilation for laparoscopic cholecystectomy. Anaesthesia 2011; 66:503-8. [PMID: 21501131 DOI: 10.1111/j.1365-2044.2011.06713.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The potential advantages of pressure-controlled over volume-controlled ventilation during laparoscopic surgery have yet to be proven. We randomly assigned 42 patients with BMI <30 kg.m(-2) scheduled for laparoscopic cholecystectomy to receive either pressure- or volume-controlled ventilation. Compared with volume-controlled ventilation, pressure-controlled ventilation resulted in a significant decrease in mean (SD) peak airway pressure at 10 min (20.4 (2.7) vs 24.0 (4.7)cmH₂O, p=0.004) and 30 min (20.7 (3.0) vs 23.9 (4.9)cmH₂O, p=0.015) and an increase in mean airway pressure at 10 min (10.5 (0.9) vs 9.6 (1.1)cmH₂O, p=0.007) and 30 min (10.5 (1.1) vs 9.6 (1.2)cmH₂O, p=0.016) after the start of surgery. Gas exchange and haemodynamic stability were similar. We conclude that pressure-controlled ventilation is a safe alternative and offers some advantages to volume-controlled ventilation during laparoscopic cholecystectomy in non-obese patients.
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Affiliation(s)
- A Tyagi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Shahadra, Delhi, India.
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26
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Montes FR, Pardo DF, Charrís H, Tellez LJ, Garzón JC, Osorio C. Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: a randomized controlled trial. J Cardiothorac Surg 2010; 5:99. [PMID: 21044330 PMCID: PMC2987929 DOI: 10.1186/1749-8090-5-99] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 11/02/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The efficacy of protective ventilation in acute lung injury has validated its use in the operating room for patients undergoing thoracic surgery with one-lung ventilation (OLV). The purpose of this study was to investigate the effects of two different modes of ventilation using low tidal volumes: pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on oxygenation and airway pressures during OLV. METHODS We studied 41 patients scheduled for thoracoscopy surgery. After initial two-lung ventilation with VCV patients were randomly assigned to one of two groups. In one group OLV was started with VCV (tidal volume 6 mL/kg, PEEP 5) and after 30 minutes ventilation was switched to PCV (inspiratory pressure to provide a tidal volume of 6 mL/kg, PEEP 5) for the same time period. In the second group, ventilation modes were performed in reverse order. Airway pressures and blood gases were obtained at the end of each ventilatory mode. RESULTS PaO2, PaCO2 and alveolar-arterial oxygen difference did not differ between PCV and VCV. Peak airway pressure was significantly lower in PCV compared with VCV (19.9 ± 3.8 cmH2O vs 23.1 ± 4.3 cmH2O; p < 0.001) without any significant differences in mean and plateau pressures. CONCLUSIONS In patients with good preoperative pulmonary function undergoing thoracoscopy surgery, the use of a protective lung ventilation strategy with VCV or PCV does not affect the oxygenation. PCV was associated with lower peak airway pressures.
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Affiliation(s)
- Félix R Montes
- Department of Anesthesiology, Fundación CardioInfantil-Instituto de Cardiología, Calle 163 A # 13B-60, Bogotá, Colombia, South América.
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Yang M, Ahn HJ, Kim K, Kim JA, Yi CA, Kim MJ, Kim HJ. Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery?: a randomized controlled trial. Chest 2010; 139:530-537. [PMID: 20829341 DOI: 10.1378/chest.09-2293] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Protective ventilation strategy has been shown to reduce ventilator-induced lung injury in patients with ARDS. In this study, we questioned whether protective ventilatory settings would attenuate lung impairment during one-lung ventilation (OLV) compared with conventional ventilation in patients undergoing lung resection surgery. METHODS One hundred patients with American Society of Anesthesiology physical status 1 to 2 who were scheduled for an elective lobectomy were enrolled in the study. During OLV, two different ventilation strategies were compared. The conventional strategy (CV group, n=50) consisted of FIO2 1.0, tidal volume (Vt) 10 mL/kg, zero end-expiratory pressure, and volume-controlled ventilation, whereas the protective strategy (PV group, n=50) consisted of FIO2 0.5, Vt 6 mL/kg, positive end-expiratory pressure 5 cm H2O, and pressure-controlled ventilation. The composite primary end point included PaO2/FIO2<300 mm Hg and/or the presence of newly developed lung lesions (lung infiltration and atelectasis) within 72 h of the operation. To monitor safety during OLV, oxygen saturation by pulse oximeter (SpO2), PaCO2, and peak inspiratory pressure (PIP) were repeatedly measured. RESULTS During OLV, although 58% of the PV group needed elevated FIO2 to maintain an SpO2>95%, PIP was significantly lower than in the CV group, whereas the mean PaCO2 values remained at 35 to 40 mm Hg in both groups. Importantly, in the PV group, the incidence of the primary end point of pulmonary dysfunction was significantly lower than in the CV group (incidence of PaO2/FIO2<300 mm Hg, lung infiltration, or atelectasis: 4% vs 22%, P<.05). CONCLUSION Compared with the traditional large Vt and volume-controlled ventilation, the application of small Vt and PEEP through pressure-controlled ventilation was associated with a lower incidence of postoperative lung dysfunction and satisfactory gas exchange. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; No.: ACTRN12609000861257; URL: www.anzctr.org.au.
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Affiliation(s)
- Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin A Yi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Joo Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
The critically ill patient who requires anesthesia is frequently a concern for the anesthesiologist. In addition to having potential hemodynamic lability and coagulopathy, the critically ill patient frequently experiences profound respiratory failure. The approach to the patient requiring advanced ventilatory support requires an understanding of respiratory failure, the pathophysiology causing respiratory failure and hypoxia, the physiology of mechanical ventilation and the advanced modes of ventilation available in the intensive care unit (ICU). This article discusses the basic definitions of hypoxia and common pathologic states, reviews the physiology of mechanical ventilation and advanced forms of ventilation available in the ICU, and concludes with recommendations for the management of patients with severe respiratory failure when they are taken to the operating room.
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Abstract
Intraoperative hypoxaemia and postoperative respiratory complications remain the challenges of modern anaesthetic practice. Anaesthesia causes both depression of respiratory centres and profound changes of respiratory mechanics. Most anaesthetized patients consequently require mechanical ventilation and supplemental oxygen. Recent data suggest that intraoperative respiratory management of a patient can affect postoperative outcome. In this review, we briefly describe the mechanisms responsible for the impairment of intraoperative gas exchange and provide guidelines to prevent or manage hypoxaemia. Moreover, we discuss several aspects of mechanical ventilation that can be employed to improve patients' outcome.
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Pressure-controlled Ventilation Does Not Improve Gas Exchange in Morbidly Obese Patients Undergoing Abdominal Surgery. Obes Surg 2007; 18:71-6. [DOI: 10.1007/s11695-007-9300-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 10/02/2007] [Indexed: 11/26/2022]
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