Tidal volume selection in volume-controlled ventilation guided by driving pressure versus actual body weight in healthy anesthetized and mechanically ventilated dogs: A randomized crossover trial
{"title":"Tidal volume selection in volume-controlled ventilation guided by driving pressure versus actual body weight in healthy anesthetized and mechanically ventilated dogs: A randomized crossover trial","authors":"","doi":"10.1016/j.vaa.2024.05.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To compare static compliance of the respiratory system (C<sub>stRS</sub>) and the ratio of partial pressure of end-tidal to arterial carbon dioxide (P<span>e′</span>CO<sub>2</sub>/PaCO<sub>2</sub><span><span>), in healthy dogs using two approaches for </span>tidal volume (V</span><sub>T</sub>) selection during volume-controlled ventilation: body mass based and driving pressure (ΔPaw) guided.</p></div><div><h3>Study design</h3><p>Randomized, nonblinded, crossover, clinical trial.</p></div><div><h3>Animals</h3><p>A total of 19 client-owned dogs anesthetized for castration and ovariohysterectomy.</p></div><div><h3>Methods</h3><p>After a stable 10 minute baseline, each dog was mechanically ventilated with a V<sub>T</sub> selection strategy, randomized to a constant V<sub>T</sub> of 15 mL kg<sup>–1</sup> of actual body mass (V<sub>TBW</sub>) or ΔPaw-guided V<sub>T</sub> (V<sub>TΔP</sub>) of 7–8 cmH<sub>2</sub>O. Both strategies used an inspiratory time of 1 second, 20% end-inspiratory pause, 4 cmH<sub>2</sub>O positive end-expiratory pressure and fraction of inspired oxygen of 0.4. Respiratory frequency was adjusted to maintain P<span>e′</span>CO<sub>2</sub><span> between 35 and 40 mmHg. Respiratory mechanics, arterial blood gases and P</span><span>e′</span>CO<sub>2</sub>/PaCO<sub>2</sub> were assessed. Continuous variables are presented as mean ± SD or median (interquartile range; quartiles 1–3), depending on distribution, and compared with Wilcoxon signed-rank tests.</p></div><div><h3>Results</h3><p>The V<sub>T</sub> was significantly higher in dogs ventilated with V<sub>TΔP</sub> than with V<sub>TBW</sub> strategy (17.20 ± 4.04 <em>versus</em> 15.03 ± 0.60 mL kg<sup>–1</sup>, <em>p</em> = 0.036). C<sub>stRS</sub> was significantly higher with V<sub>TΔP</sub> than with V<sub>TBW</sub> strategy [2.47 (1.86–2.86) <em>versus</em> 2.25 (1.79–2.58) mL cmH<sub>2</sub>O<sup>−1</sup> kg<sup>–1</sup>, <em>p</em> = 0.011]. There were no differences in P<span>e′</span>CO<sub>2</sub>/PaCO<sub>2</sub> between V<sub>TΔP</sub> and V<sub>TBW</sub> strategies (0.94 ± 0.06 <em>versus</em> 0.92 ± 0.06, <em>p</em> = 0.094). No discernible difference in ΔPaw was noted between the strategies.</p></div><div><h3>Conclusions and clinical relevance</h3><p>While no apparent difference was observed in the P<span>e′</span>CO<sub>2</sub>/PaCO<sub>2</sub> between the V<sub>T</sub> selection strategies employed, C<sub>stRS</sub> significantly increased during the V<sub>TΔP</sub> approach. A future trial should explore if V<sub>TΔP</sub> improves perioperative gas exchange and prevents lung damage.</p></div>","PeriodicalId":23626,"journal":{"name":"Veterinary anaesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Veterinary anaesthesia and analgesia","FirstCategoryId":"97","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1467298724000837","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
To compare static compliance of the respiratory system (CstRS) and the ratio of partial pressure of end-tidal to arterial carbon dioxide (Pe′CO2/PaCO2), in healthy dogs using two approaches for tidal volume (VT) selection during volume-controlled ventilation: body mass based and driving pressure (ΔPaw) guided.
A total of 19 client-owned dogs anesthetized for castration and ovariohysterectomy.
Methods
After a stable 10 minute baseline, each dog was mechanically ventilated with a VT selection strategy, randomized to a constant VT of 15 mL kg–1 of actual body mass (VTBW) or ΔPaw-guided VT (VTΔP) of 7–8 cmH2O. Both strategies used an inspiratory time of 1 second, 20% end-inspiratory pause, 4 cmH2O positive end-expiratory pressure and fraction of inspired oxygen of 0.4. Respiratory frequency was adjusted to maintain Pe′CO2 between 35 and 40 mmHg. Respiratory mechanics, arterial blood gases and Pe′CO2/PaCO2 were assessed. Continuous variables are presented as mean ± SD or median (interquartile range; quartiles 1–3), depending on distribution, and compared with Wilcoxon signed-rank tests.
Results
The VT was significantly higher in dogs ventilated with VTΔP than with VTBW strategy (17.20 ± 4.04 versus 15.03 ± 0.60 mL kg–1, p = 0.036). CstRS was significantly higher with VTΔP than with VTBW strategy [2.47 (1.86–2.86) versus 2.25 (1.79–2.58) mL cmH2O−1 kg–1, p = 0.011]. There were no differences in Pe′CO2/PaCO2 between VTΔP and VTBW strategies (0.94 ± 0.06 versus 0.92 ± 0.06, p = 0.094). No discernible difference in ΔPaw was noted between the strategies.
Conclusions and clinical relevance
While no apparent difference was observed in the Pe′CO2/PaCO2 between the VT selection strategies employed, CstRS significantly increased during the VTΔP approach. A future trial should explore if VTΔP improves perioperative gas exchange and prevents lung damage.
期刊介绍:
Veterinary Anaesthesia and Analgesia is the official journal of the Association of Veterinary Anaesthetists, the American College of Veterinary Anesthesia and Analgesia and the European College of Veterinary Anaesthesia and Analgesia. Its purpose is the publication of original, peer reviewed articles covering all branches of anaesthesia and the relief of pain in animals. Articles concerned with the following subjects related to anaesthesia and analgesia are also welcome:
the basic sciences;
pathophysiology of disease as it relates to anaesthetic management
equipment
intensive care
chemical restraint of animals including laboratory animals, wildlife and exotic animals
welfare issues associated with pain and distress
education in veterinary anaesthesia and analgesia.
Review articles, special articles, and historical notes will also be published, along with editorials, case reports in the form of letters to the editor, and book reviews. There is also an active correspondence section.