Montes Félix R, Pardo Daniel F, Charrís Hernán, Tellez Luis J, Garzón Juan C, Osorio Camilo
Department of Anesthesiology, Fundación CardioInfantil-Instituto de Cardiología, Calle 163 A # 13B-60, Bogotá, Colombia, South América.
J Cardiothorac Surg. 2010 Nov 2;5:99. doi: 10.1186/1749-8090-5-99.
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.
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.
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.
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.
保护性通气在急性肺损伤中的疗效已证实其可用于接受单肺通气（OLV）的胸科手术患者的手术室。本研究的目的是探讨两种不同的低潮气量通气模式：压力控制通气（PCV）与容量控制通气（VCV）对OLV期间氧合和气道压力的影响。
我们研究了41例计划进行胸腔镜手术的患者。在最初用VCV进行双肺通气后，患者被随机分为两组。一组以VCV开始OLV（潮气量6 mL/kg，呼气末正压5），30分钟通气后在相同时间段内切换为PCV（吸气压力以提供6 mL/kg的潮气量，呼气末正压5）。在第二组中，通气模式以相反顺序进行。在每种通气模式结束时获取气道压力和血气。
PCV和VCV之间的动脉血氧分压、动脉血二氧化碳分压和肺泡 - 动脉血氧分压差无差异。与VCV相比，PCV的气道峰值压力显著更低（19.9±3.8 cmH₂O对23.1±4.3 cmH₂O；p<0.001），平均压力和平台压力无显著差异。
在术前肺功能良好且接受胸腔镜手术的患者中，采用VCV或PCV的保护性肺通气策略不影响氧合。PCV与更低的气道峰值压力相关。
