Flow-controlled versus pressure-controlled ventilation in thoracic surgery with one-lung ventilation – A randomized controlled trial

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-27 DOI:10.1016/j.jclinane.2025.111785

Julia Abram MD , Patrick Spraider PhD , Judith Martini MD , Corinna Velik-Salchner MD , Hannes Dejaco MD , Florian Augustin MD , Gabriel Putzer MD , Tobias Hell PhD , Tom Barnes PhD , Dietmar Enk MD

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引用次数: 0

Abstract

Study objective

Comparison of flow-controlled ventilation (FCV) to standard of pressure-controlled ventilation (PCV) in thoracic surgery procedures requiring one-lung ventilation.

Design

Prospective, non-blinded, randomized, controlled trial.

Setting

Operating theater at a university hospital, Austria.

Patients

Patients scheduled for elective, thoracic surgery.

Interventions

Participants received ventilation randomly either with FCV or PCV per-protocol for the duration of anesthesia.

Measurements

The primary endpoint was oxygenation assessed by paO₂ / FiO₂ ratio 30 min after the start of OLV. Secondary endpoints included the required minute volume for CO₂ removal, applied mechanical power and incidence of postoperative pulmonary complications.

Main results

A total of 46 patients were enrolled and 43 included in the primary analysis. The primary endpoint paO₂ / FiO₂ ratio was significantly higher in the FCV group (n = 21) compared to the control group (PCV n = 22) (187 vs 136 mmHg, MD 39 (95 % CI 1 to 75); p = 0.047). The required respiratory minute volume to obtain comparable mild hypercapnia during OLV was significantly lower in FCV (3.0 vs 4.5 l/min, MD -1.3 (95 % CI -1.9 to −0.8); p < 0.001). The applied mechanical power was also significantly lower (3.5 versus 7.6 J/min, MD -3.8 (95 % CI -5.3 to −2.7); p < 0.001).

Conclusions

In this single-center randomized controlled trial, flow-controlled ventilation improved gas exchange parameters in terms of oxygenation and carbon dioxide removal during one-lung ventilation in patients undergoing thoracic surgery and reduced the mechanical impact of artificial ventilation.

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单肺通气胸外科手术中流量控制与压力控制通气-一项随机对照试验

研究目的比较单肺通气胸外科手术中流量控制通气（FCV）与标准压力控制通气（PCV）的差异。前瞻性、非盲法、随机对照试验。奥地利一所大学医院的手术室。病人预定进行选择性胸外科手术的病人。干预措施：在麻醉期间，参与者随机接受FCV或PCV通气。主要终点是在OLV开始后30分钟通过paO2 / FiO2比率评估氧合。次要终点包括CO2去除所需的分钟体积、施加的机械功率和术后肺部并发症的发生率。主要结果共纳入46例患者，其中43例纳入初步分析。主要终点paO2 / FiO2比值在FCV组（n = 21）显著高于对照组（PCV n = 22） (187 vs 136 mmHg, MD 39 (95% CI 1 ~ 75)；p = 0.047)。FCV患者在OLV期间获得类似轻度高碳酸血症所需的呼吸分钟体积显著降低(3.0 vs 4.5 l/min, MD -1.3 (95% CI -1.9至- 0.8)；p & lt;0.001)。施加的机械功率也显著降低(3.5 vs 7.6 J/min, MD -3.8 (95% CI -5.3至- 2.7)；p & lt;0.001)。结论在这项单中心随机对照试验中，流量控制通气改善了胸外科手术患者单肺通气过程中氧合和二氧化碳去除方面的气体交换参数，降低了人工通气的机械影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.