Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial
Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial
复制标题
DOI：
10.3390/jcm8122032
复制
发表时间：
2019-12-01
影响因子：
3.9
通讯作者：
Kim, Min-Soo
中科院分区：
文献类型：
--
作者：
Park, Jin Ha;Park, In Kyeong;Kim, Min-Soo
双控制通气（DCV）结合了容量控制通气（VCV）和压力控制通气（PCV）的优点。机器人辅助腹腔镜根治性直肠癌切除术（RALRP）的二氧化碳（CO2）气腹和陡峭的Trendelenburg体位对呼吸系统有负面影响。我们假设使用自动血流作为一种类型的DCV可以减少RALRP期间的这些影响。80例接受RALRP的患者被随机分配接受VCV或DCV。在4个时间点比较动脉血氧分压（PaO 2）作为主要结局、呼吸和血流动力学数据以及术后发热率：麻醉诱导后10 min（T1）、开始CO2气腹和Trendelenburg体位后30 min和60 min（T2和T3）以及仰卧位后10 min（T4）。两组PaO 2无显著性差异。在T2（平均差异，5.0 cm H2O;校正后p < 0.001）和T3（平均差异，3.9 cm H2O;校正后p <0.001）时，DCV组的平均气道峰压（Ppeak）显著低于VCV组。术后2天内发生的术后发热在VCV组（12%）中比在DCV组（3%）中更常见（p = 0.022）。与VCV相比，DCV在RALRP期间没有改善氧合。然而，DCV显著降低Ppeak，而无血流动力学不稳定。
Dual-controlled ventilation (DCV) combines the advantages of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning for robot-assisted laparoscopic radical prostatectomy (RALRP) has negative effects on the respiratory system. We hypothesized that the use of autoflow as one type of DCV can reduce these effects during RALRP. Eighty patients undergoing RALRP were randomly assigned to receive VCV or DCV. Arterial oxygen tension (PaO2) as the primary outcome, respiratory and hemodynamic data, and postoperative fever rates were compared at four time points: 10 min after anesthesia induction (T1), 30 and 60 min after the initiation of CO2 pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after supine positioning (T4). There were no significant differences in PaO2 between the two groups. Mean peak airway pressure (Ppeak) was significantly lower in group DCV than in group VCV at T2 (mean difference, 5.0 cm H2O; adjusted p < 0.001) and T3 (mean difference, 3.9 cm H2O; adjusted p < 0.001). Postoperative fever occurring within the first 2 days after surgery was more common in group VCV (12%) than in group DCV (3%) (p = 0.022). Compared with VCV, DCV did not improve oxygenation during RALRP. However, DCV significantly decreased Ppeak without hemodynamic instability.