Comparison of pressure controlled, volume controlled, and volume guaranteed pressure controlled modes in prone position in patients operated for lumbar disc herniation A randomized trial


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Günenç S. F., Seyidova I., Özbilgin Ş., Ur K., Hancı V.

MEDICINE, vol.103, no.6, pp.103-111, 2024 (SCI-Expanded)

  • Publication Type: Article / Article
  • Volume: 103 Issue: 6
  • Publication Date: 2024
  • Doi Number: 10.1097/md.0000000000037227
  • Journal Name: MEDICINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, CINAHL, Veterinary Science Database, Directory of Open Access Journals
  • Page Numbers: pp.103-111
  • Dokuz Eylül University Affiliated: Yes

Abstract

Background: To compare pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes in patients undergoing spinal surgery in the prone position under general anesthesia. Methods: The study included 78 patients aged 20 to 80 years, American Society of Anesthesiologists 1–2, scheduled for lumbar spinal surgery. Patients included in the study were randomly divided into 3 groups Group-VCV; Group-PCV; Group-PCV-VG. Standard anesthesia protocol was applied. In addition to routine monitoring, train of four and BIS monitoring were performed. All ventilation modes were set with a target tidal volume of 6 to 8mL/kg, FiO2: 0.40–0.45 and a respiratory rate of normocarbia. Positive end-expiratory pressure: 5cm H2 O, inspiration/expiration ratio = 1:2, and the maximum airway pressure:40cm H2 O. Hemodynamic, respiratory variables and arterial blood gases was measured, 15 minutes after induction of anesthesia in the supine position (T1), after prone position 15 minutes (T2), 30 minutes (T3), 45 minutes (T4), 60 minutes (T5), 75 minutes (T6), 90 minutes (T7). Results: There was no significant difference between the groups in patient characteristics. SAP, DAP, mean arterial pressure, and heart rate decreased after being placed in the prone position in all groups. Hemodynamic variables did not differ significantly between the groups. partial arterial oxygen pressure and arterial oxygen saturation levels in blood gas were found to be significantly higher in Group-PCV-VG compared to Group-PCV and Group-VCV in both the supine and prone positions. Ppeak and plateau airway pressure (Pplato) values increased and dynamic lung compliance (Cdyn) values decreased after placing the patients in the prone position in all groups. Lower Ppeak and Pplato values and higher Cdyn values were observed in both the supine and prone positions in the Group-PCV-VG group compared to the Group-PCV and Group-VCV groups. Conclusion: PCV-VG provides lower Ppeak and Pplato values, as well as better Cdyn, oxygenation values compared to PCV and VCV. So that PCV-VG may be an effective alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery. Abbreviations: ASA = American Society of Anesthesiologists, BIS = bispectral index, BMI = body mass index, Cdyn = dynamic lung compliance, DBP = diastolic blood pressure, HR = heart rate, MAP = mean arterial pressure, PaCO2 = partial arterial carbon dioxide pressure, PaO2 = partial arterial oxygen pressure, PCV = pressure-controlled ventilation, PCV-VG = pressure-controlled ventilation-volume guaranteed, Pmean = mean airway pressure, Ppeak = peak airway pressure, Pplato = plateau airway pressure, SaO2 = arterial oxygen saturation, TOF = train of four, VCV = volume-controlled ventilation, VT = tidal volume. Keywords: prone position, spine surgery, ventilation modes