Schick Volker, Dusse Fabian, Eckardt Ronny, Kerkhoff Steffen, Commotio Simone, Hinkelbein Jochen, Mathes Alexander
Department of Anesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne University, Kerpener Str. 62, 50937 Cologne, Germany.
J Clin Med. 2021 Mar 19;10(6):1276. doi: 10.3390/jcm10061276.
For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named "volume-guaranteed" or "volume-targeted" pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (P, P, P), dynamic compliance (C), or arterial blood gases (PO, PCO) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ test and the I statistic. As primary endpoints, P, P, P, C, PO, and PCO were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced P (15 studies) and P (9 studies) as well as higher C (9 studies), compared with VCV [random effects models; P: CI -3.26 to -1.47; < 0.001; I = 82%; P: -3.12 to -0.12; = 0.03; I = 90%; C: CI 3.42 to 8.65; < 0.001; I = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower P and higher PO compared with VCV. In Trendelenburg position (5 studies), this effect was significant for P only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.
对于全身麻醉下的围手术期机械通气，现代呼吸机旨在将压力控制通气（PCV）和容量控制通气（VCV）的优点结合起来，采用通常称为“容量保证”或“容量靶向”的压力控制通气（PCV-VG）模式。本系统评价和荟萃分析检验了这样一个假设：对于接受全身麻醉下择期手术的成年人，PCV-VG通气模式在改善气道压力（P、P、P）、动态顺应性（C）或动脉血气（PO、PCO）方面可能是有益的。使用预定义的检索策略检索了三个主要的医学电子数据库，并根据Cochrane综述方法对出版物进行了系统评价。使用逆方差法检验连续变量的均值差异，并计算95%置信区间（CI）。基于各研究间干预效果不相同的假设，选择了随机效应模型。用χ检验和I统计量进行异质性评估。将P、P、P、C、PO和PCO作为主要终点进行评估。在识别出的725篇出版物中，17篇最终符合纳入标准，共纳入929例患者。在仰卧位双肺通气时，与VCV相比，PCV-VG导致P（15项研究）和P（9项研究）显著降低，C（9项研究）升高[随机效应模型；P：CI -3.26至-1.47；<0.001；I = 82%；P：-3.12至-0.12；= 0.03；I = 90%；C：CI 3.42至8.65；<0.001；I = 90%]。对于单肺通气（8项研究），与VCV相比，PCV-VG可使P显著降低，PO升高。在Trendelenburg体位（5项研究），仅P有显著影响。本系统评价和荟萃分析表明，容量靶向压力控制通气模式可能在改善双肺和单肺通气时的气道动力学以及改善接受择期手术的成年人单肺通气时的氧合方面具有益处。
