Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou 310052, China.
Department of Neurological Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou 310052, China.
J Clin Anesth. 2024 Aug;95:111440. doi: 10.1016/j.jclinane.2024.111440. Epub 2024 Mar 8.
To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled ventilation (VCV) in optimizing intraoperative respiratory mechanics in infants and young children in the prone position.
A single-center prospective randomized study.
Children's Hospital, Zhejiang University School of Medicine.
Pediatric patients aged 1 month to 3 years undergoing elective spinal cord detethering surgery.
Patients were randomly allocated to the VCV group, PCV group and PCV-VG group. The target tidal volume (V) was 8 mL/kg and the respiratory rate (RR) was adjusted to maintain a constant end tidal CO.
The primary outcome was intraoperative peak airway pressure (Ppeak). Secondary outcomes included other respiratory and ventilation variables, gas exchange values, serum lung injury biomarkers concentration, hemodynamic parameters and postoperative respiratory complications.
A total of 120 patients were included in the final analysis (40 in each group). The VCV group showed higher Ppeak at T2 (10 min after prone positioning) and T3 (30 min after prone positioning) than the PCV and PCV-VG groups (T2: P = 0.015 and P = 0.002, respectively; T3: P = 0.007 and P = 0.009, respectively). The prone-related decrease in dynamic compliance was prevented by PCV and PCV-VG ventilation modalities at T2 and T3 than by VCV (T2: P = 0.008 and P = 0.015, respectively; T3: P = 0.015 and P = 0.014, respectively). Additionally, there were no significant differences in other secondary outcomes among the three groups.
In infants and young children undergoing spinal cord detethering surgery in the prone position, PCV-VG may be a better ventilation mode due to its ability to mitigate the increase in Ppeak and decrease in Cdyn while maintaining consistent V.
探讨压力控制通气（PCV）和压力控制通气-容量保证（PCV-VG）模式是否优于容量控制通气（VCV），以优化俯卧位婴幼儿术中呼吸力学。
单中心前瞻性随机研究。
浙江大学医学院附属儿童医院。
择期行脊髓松解术的 1 个月至 3 岁小儿患者。
患者随机分配至 VCV 组、PCV 组和 PCV-VG 组。目标潮气量（V）为 8 mL/kg，呼吸频率（RR）调整以维持恒定的呼气末 CO。
主要结局指标为术中气道峰压（Ppeak）。次要结局指标包括其他呼吸和通气变量、血气交换值、血清肺损伤生物标志物浓度、血流动力学参数和术后呼吸并发症。
共有 120 例患者纳入最终分析（每组 40 例）。VCV 组在 T2（俯卧位后 10 min）和 T3（俯卧位后 30 min）时的 Ppeak 高于 PCV 和 PCV-VG 组（T2：P = 0.015 和 P = 0.002；T3：P = 0.007 和 P = 0.009）。与 VCV 相比，PCV 和 PCV-VG 通气模式在 T2 和 T3 时可预防俯卧位相关的动态顺应性下降（T2：P = 0.008 和 P = 0.015；T3：P = 0.015 和 P = 0.014）。此外，三组间其他次要结局指标无显著差异。
在俯卧位行脊髓松解术的婴幼儿中，PCV-VG 可能是一种更好的通气模式，因为它可以减轻 Ppeak 的增加和动态顺应性的降低，同时保持一致的 V。
