Pressure-controlled versus Volume-controlled Ventilation during One Lung Ventilation for Empyema Thoracis: A Randomised Control Trial
Published: May 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/68754.19416
Shefali Gautam, Deepali Chandra, Kirtika Yadav, Neel Kamal Mishra, Sanjeev Kumar, Ravi Prakash, Dinesh Singh, Abhishek Rajput
1. Additional Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
2. Senior Resident, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
3. Assistant Professor, Department of Anaesthesiology, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India.
4. Assistant Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
5. Additional Professor, Department of General Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India.
6. Assistant Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
7. Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
8. Associate Consultant, Department of Anaesthesiology, Medanta Hospital, Lucknow, Uttar Pradesh, India.
Correspondence
Neel Kamal Mishra,
Assistant Professor, Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India.
E-mail: mishraneelkamal83@gmail.com
Introduction: Volume Controlled Ventilation (VCV) is traditionally used during One Lung Ventilation (OLV); however, it is associated with complications such as volutrauma and barotrauma. On the other hand, Pressure Controlled Ventilation (PCV) allows the delivery of a required tidal volume at lower airway pressures, leading to enhanced oxygenation and ventilation.
Aim: To compare VCV and PCV modes for OLV in patients undergoing surgery for empyema thoracis.
Materials and Methods: A randomised controlled trial was conducted among 50 patients requiring OLV. The participants were divided into two groups, namely Group-V and Group-P, with each group receiving VCV and PCV, respectively. The two groups were compared based on the partial pressure of oxygen (during the intraoperative and post-operative period), peak and plateau airway pressures, lung compliance, and complications. The groups were analysed using the Chi-square test, and the threshold of statistical significance was set at a p-value <0.05.
Results: Fifty participants were divided into two groups: VCV (n=25) and PCV (n=25). Both study groups were found to be comparable in terms of demographic details, haemodynamic parameters, and duration of surgery. The mean age of the patients was 27.80 years in Group-V and 31.04 years in Group-P. The authors observed improved PaO2 levels, lung compliance, and reduced peak pressures during OLV in the PCV group. After lung isolation, PaO2 levels of Group-P patients (93.64±5.154 mmHg) were higher compared to Group-V (81.38±7.975 mmHg) at 50% FiO2 (p-value <0.001). Similarly, post-extubation PaO2 levels were better in Group-P (99.24±18.58 mmHg) than in Group-V (84.35±7.677 mmHg) at 36% FiO2 (p-value <0.001). The mean peak pressures were lower in Group-P (25.17±4.34 cm H2O) than in Group-V (28.22±4.51 cm H2O). Additionally, there was a statistically significant improvement in lung compliance among Group-P patients (p-value=0.0144).
Conclusion: Thus, it can be inferred that PCV improves oxygenation and reduces airway pressures during OLV. However, there was no significant difference seen between the two modes in terms of post-operative pulmonary complications.
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