Comparison of volume-controlled ventilation, pressure-controlled ventilation and pressure-controlled ventilation-volume guaranteed in infants and young children in the prone position: A prospective randomized study - 25/04/24
Abstract |
Study objective |
To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled ventilation (VCV) in optimizing intraoperative respiratory mechanics in infants and young children in the prone position.
Design |
A single-center prospective randomized study.
Setting |
Children's Hospital, Zhejiang University School of Medicine.
Patients |
Pediatric patients aged 1 month to 3 years undergoing elective spinal cord detethering surgery.
Interventions |
Patients were randomly allocated to the VCV group, PCV group and PCV-VG group. The target tidal volume (VT) was 8 mL/kg and the respiratory rate (RR) was adjusted to maintain a constant end tidal CO2.
Measurements |
The primary outcome was intraoperative peak airway pressure (Ppeak). Secondary outcomes included other respiratory and ventilation variables, gas exchange values, serum lung injury biomarkers concentration, hemodynamic parameters and postoperative respiratory complications.
Main results |
A total of 120 patients were included in the final analysis (40 in each group). The VCV group showed higher Ppeak at T2 (10 min after prone positioning) and T3 (30 min after prone positioning) than the PCV and PCV-VG groups (T2: P = 0.015 and P = 0.002, respectively; T3: P = 0.007 and P = 0.009, respectively). The prone-related decrease in dynamic compliance was prevented by PCV and PCV-VG ventilation modalities at T2 and T3 than by VCV (T2: P = 0.008 and P = 0.015, respectively; T3: P = 0.015 and P = 0.014, respectively
Additionally, there were no significant differences in other secondary outcomes among the three groups.
Conclusion |
In infants and young children undergoing spinal cord detethering surgery in the prone position, PCV-VG may be a better ventilation mode due to its ability to mitigate the increase in Ppeak and decrease in Cdyn while maintaining consistent VT.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Studies of ventilation strategies in infants and young children during prone position are limited. |
• | VCV mode showed higher Ppeak and lower Cdyn than PCV-VG and PCV modes during prone position. |
• | VCV and PCV-VG modes showed more stable tidal volume than PCV mode during prone position. |
Keywords : Mechanical ventilation mode, Prone position, Pediatrics, Spinal cord detethering surgery, Respiratory mechanics
Plan
Vol 95
Article 111440- août 2024 Retour au numéro
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