Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
J Clin Anesth. 2023 Dec;91:111279. doi: 10.1016/j.jclinane.2023.111279. Epub 2023 Oct 3.
Multifactorial comparison of flow-controlled ventilation (FCV) to standard of pressure-controlled ventilation (PCV) in terms of oxygenation in cardiac surgery patients after chest closure.
Prospective, non-blinded, randomized, controlled trial.
Operating theatre at an university hospital, Austria.
Patients scheduled for elective, open, on-pump, cardiac surgery.
Participants were randomized to either individualized FCV (compliance guided end-expiratory and peak pressure setting) or control of PCV (compliance guided end-expiratory pressure setting and tidal volume of 6-8 ml/kg) for the duration of surgery.
The primary outcome measure was oxygenation (PaO/FiO) 15 min after intraoperative chest closure. Secondary endpoints included CO-removal assessed as required minute volume to achieve normocapnia and lung tissue aeration assessed by Hounsfield unit distribution in postoperative computed tomography scans.
Between April 2020 and April 2021 56 patients were enrolled and 50 included in the primary analysis (mean age 70 years, 38 (76%) men). Oxygenation, assessed by PaO/FiO, was significantly higher in the FCV group (n = 24) compared to the control group (PCV, n = 26) (356 vs. 309, median difference (MD) 46 (95% CI 3 to 90) mmHg; p = 0.038). Additionally, the minute volume required to obtain normocapnia was significantly lower in the FCV group (4.0 vs. 6.1, MD -2.0 (95% CI -2.5 to -1.5) l/min; p < 0.001) and correlated with a significantly lower exposure to mechanical power (5.1 vs. 9.8, MD -5.1 (95% CI -6.2 to -4.0) J/min; p < 0.001). Evaluation of lung tissue aeration revealed a significantly reduced amount of non-aerated lung tissue in FCV compared to PCV (5 vs. 7, MD -3 (95% CI -4 to -1) %; p < 0.001).
In patients undergoing on-pump, cardiac surgery individualized FCV significantly improved oxygenation and lung tissue aeration compared to PCV. In addition, carbon dioxide removal was accomplished at a lower minute volume leading to reduced applied mechanical power.
在心脏手术后患者关胸时，对比流量控制通气（FCV）和标准压力控制通气（PCV）在氧合方面的多因素差异。
前瞻性、非盲、随机、对照试验。
奥地利一家大学医院的手术室。
择期、开放、体外循环、心脏手术患者。
参与者随机分配至个体化 FCV（顺应性引导的呼气末和峰压设置）或 PCV 控制（顺应性引导的呼气末压设置和潮气量 6-8ml/kg），持续至手术结束。
主要结局测量为术中关胸后 15 分钟的氧合（PaO/FiO）。次要终点包括通过术后计算机断层扫描的亨氏单位分布评估的二氧化碳去除（达到正常碳酸血症所需的分钟通气量）和肺组织充气。
2020 年 4 月至 2021 年 4 月期间，共纳入 56 例患者，其中 50 例纳入主要分析（平均年龄 70 岁，38 例（76%）为男性）。FCV 组（n=24）的氧合（PaO/FiO）显著高于对照组（PCV，n=26）（356 对 309，中位数差值（MD）46（95%CI 3-90）mmHg；p=0.038）。此外，FCV 组获得正常碳酸血症所需的分钟通气量显著降低（4.0 对 6.1，MD-2.0（95%CI-2.5 至-1.5）l/min；p<0.001），与机械功率的暴露显著降低相关（5.1 对 9.8，MD-5.1（95%CI-6.2 至-4.0）J/min；p<0.001）。肺组织充气评估显示，FCV 组非充气肺组织的量明显低于 PCV 组（5 对 7，MD-3（95%CI-4 至-1）%；p<0.001）。
在接受体外循环心脏手术的患者中，与 PCV 相比，个体化 FCV 显著改善了氧合和肺组织充气。此外，二氧化碳去除量在较低的分钟通气量下完成，导致应用的机械功率降低。
