[Effects of volume-controlled ventilation and pressure-controlled volume- guaranteed mode during one-lung ventilation on circulation, pulmonary function and lung injury].

OBJECTIVE

To compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed (PCV-VG) mode during one-lung ventilation (OLV) on circulation, pulmonary function and lung injury.

METHODS

2012 February to 2013 March in Ningbo No2. Hospital cardiothoracic surgery, 30 patients aged 52 to 76 years (ASA grade II-III) undergoing elective thoracoscopic lobectomy were randomly divided into VCV group and PCV-VG group, with 15 cases in each group. After anesthesia induction and endotracheal intubation, endobronchial blocker was inserted to start OLV. Heart rate (HR), mean arterial pressure (MAP), measured tidal volume (TV), peak airway pressure (Ppeak), airway resistance (Raw), chest compliance (Cdyn) and the end-tidal carbon dioxide pressure (PetCO(2)) were recorded at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation. In the meanwhile, arterial blood gas analysis was conducted to measure indicators of pH, oxygen tension (PaO(2)) and carbon dioxide partial pressure (PaCO(2)). Blood was drawn before induction, 1 hour after OLV and 1 hour after the end of surgery, and the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA).

RESULTS

HR, MAP, TV, PetCO(2), pH and PaCO(2) in two groups at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation showed no significant difference (P > 0.05). At the point of 15 minutes after turning to the lateral position and 15 minutes after two lung ventilation, Ppeak and Cdyn of two groups were significantly different (P < 0.05) (Ppeak:16 ± 3 cmH(2)O, 16 ± 3 cmH(2)O for VCV group and 14 ± 2 cmH(2)O, 14 ± 2 cmH(2)O for PCV-VG group; Cdyn: 43.5 ± 5.9 ml/cmH(2)O, 43.8 ± 6.7 ml/cmH2O for VCV group and 49.7 ± 7.1 ml/cmH(2)O, 53.3 ± 9.6 ml/cmH(2)O for PCV-VG group). Compared with VCV group, PCV-VG group showed a lower Ppeak 15 minutes and 60 minutes after OLV [ (17 ± 2 cmH(2)O) vs (22 ± 4 cmH(2)O) and (18 ± 4 cmH(2)O) vs( 23 ± 3 cmH(2)O) with a higher Cdyn at the same point (38.6 ± 6.3 ml/cmH(2)O) vs (29.6 ± 3.2 ml/cmH(2)O) and 37.3 ± 6.0 ml/cmH(2)O) vs (30.3 ± 3.8 ml/cmH(2)O)] (P < 0.01). Compared with VCV group,IL-6 and TNF-α of PCV-VG group 1 hour after OLV and 1 hour after the end of surgery were significantly lower (P < 0.01) (IL-6: 52.32 ± 3.59 vs 62.65 ± 4.17 pg/ml and 63.57 ± 4.98 vs 82.38 ± 4.10 pg/ml; TNF-α: 3.23 ± 0.27 vs 4.19 ± 0.38 pg/ml and 4.01 ± 0.28 vs. 5.49 ± 0.31 pg/ml).

CONCLUSION

During one-lung ventilation in thoracoscopic lobectomy, PCV-VG mode has a competitive advantage over VCV mode in terms of pulmonary function and lung protection.