Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation – A randomized controlled trial - 12/05/25
, Corinna Velik-Salchner, MD a, Hannes Dejaco, MD a, Florian Augustin, MD b, Gabriel Putzer, MD a, Tobias Hell, PhD c, Tom Barnes, PhD d, Dietmar Enk, MD eAbstract |
Study objective |
Comparison of flow-controlled ventilation (FCV) to standard of pressure-controlled ventilation (PCV) in thoracic surgery procedures requiring one-lung ventilation.
Design |
Prospective, non-blinded, randomized, controlled trial.
Setting |
Operating theater at a university hospital, Austria.
Patients |
Patients scheduled for elective, thoracic surgery.
Interventions |
Participants received ventilation randomly either with FCV or PCV per-protocol for the duration of anesthesia.
Measurements |
The primary endpoint was oxygenation assessed by paO2 / FiO2 ratio 30 min after the start of OLV. Secondary endpoints included the required minute volume for CO2 removal, applied mechanical power and incidence of postoperative pulmonary complications.
Main results |
A total of 46 patients were enrolled and 43 included in the primary analysis. The primary endpoint paO2 / FiO2 ratio was significantly higher in the FCV group (n = 21) compared to the control group (PCV n = 22) (187 vs 136 mmHg, MD 39 (95 % CI 1 to 75); p = 0.047). The required respiratory minute volume to obtain comparable mild hypercapnia during OLV was significantly lower in FCV (3.0 vs 4.5 l/min, MD -1.3 (95 % CI -1.9 to −0.8); p < 0.001). The applied mechanical power was also significantly lower (3.5 versus 7.6 J/min, MD -3.8 (95 % CI -5.3 to −2.7); p < 0.001).
Conclusions |
In this single-center randomized controlled trial, flow-controlled ventilation improved gas exchange parameters in terms of oxygenation and carbon dioxide removal during one-lung ventilation in patients undergoing thoracic surgery and reduced the mechanical impact of artificial ventilation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Flow-controlled ventilation lowers mechanic impact by a constant gas flow. |
• | During one-lung ventilation this strategy improved gas exchange compared to control. |
• | In addition, the applied mechanical power of ventilation was reduced to half. |
• | This may indicate a novel lung protective strategy in thoracic surgery. |
Keywords : Flow-controlled ventilation, Gas exchange, pulmonary, Mechanical power, One-lung ventilation, Pressure-controlled ventilation, Surgery, thoracic
Plan
Vol 103
Article 111785- avril 2025 Retour au numéro
Article précédent
- Richard (Rick) Dutton MD
- Association between baseline cerebral oxygenation and postoperative outcomes in older noncardiac surgical patients: An exploratory observational study
- Mariana Thedim, Maria J. Susano, Francisco S. Seixas, Sérgio Vide, Susana Vacas, Pedro Amorim
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?