Effect of pressure-controlled ventilation and volume-controlled ventilation for laparoscopic surgery in the Trendelenburg position: a systematic review and meta-analysis.

IF 2 3区 医学 Q2 ANESTHESIOLOGY
Cui Wen, Yi Qi, Yingying Xiang, Qianyun Pang, Jingyu Xiao, Ran An
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Abstract

Background: Volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are commonly used in laparoscopic surgery in the Trendelenburg position, and pressure-controlled ventilation volume guaranteed (PCV-VG) has been increasingly used recently. However, there is still no consensus on the optimal ventilation mode. Therefore, a systematic review and meta-analysis were conducted to compare the effects of different ventilation modes for laparoscopic surgery in the Trendelenburg position.

Methods: Multiple databases were searched for randomized controlled trials published before December 2024 to compare the effects of PCV, PCV-VG, and VCV in patients in the Trendelenburg position who underwent laparoscopic surgery. The primary outcomes included peak airway pressure (Ppeak), plateau airway pressure (Pplat), dynamic compliance (Cdyn), and blood gas analysis.

Results: Sixteen studies were included in this meta-analysis. PCV [Ppeak, 15‒40-min post-pneumoperitoneum and Trendelenburg position (T2): mean difference (MD) - 4.28, 95% confidence interval (CI) - 5.91 to - 2.64, P < 0.01; 60-min post-pneumoperitoneum and Trendelenburg position (T3): MD - 4.51, 95% CI - 5.41 to - 3.6, P < 0.01; 120-min post-pneumoperitoneum and Trendelenburg position (T4): MD - 5.63, 95% CI - 7.35 to - 3.91, P < 0.01; Cydn, T2: MD 3.15, 1.53 to 4.77, P = 0.0001; T3: MD 2.78, 95% CI 1.43 to 4.14, P < 0.01] and PCV-VG (Ppeak, T2: MD - 3.99, 95% CI - 7.2 to - 0.78, P = 0.01; T3: MD - 3.46, 95% CI - 6.5 to - 0.42, P = 0.03; Cydn, T3: MD 4.44, 95% CI 2.23 to 6.66, P < 0.01; T4: MD 3.61, 95% CI 1.31 to 5.91, P = 0.002) significantly reduced Ppeak and improved Cydn compared with VCV after pneumoperitoneum and Trendelenburg position. PaO2, pH, and PaO2/FiO2 did not differ between PCV and VCV or between PCV-VG and VCV during intraoperative surgery.

Conclusions: Our meta-analysis suggests that in laparoscopic surgery in the Trendelenburg position, PCV or PCV-VG can provide a lower Ppeak and higher Cdyn throughout surgery but cannot offer better oxygenation than VCV. PCV or PCV-VG might be optimal for laparoscopic surgery in the Trendelenburg position.

压力控制通气和容量控制通气在Trendelenburg体位腹腔镜手术中的效果:系统回顾和meta分析。
背景:容量控制通气(VCV)和压力控制通气(PCV)是Trendelenburg体位腹腔镜手术中常用的两种通气方式,近年来压力控制通气(PCV- vg)的应用越来越广泛。然而,对于最佳通风方式仍未达成共识。因此,我们对Trendelenburg体位腹腔镜手术中不同通气方式的效果进行了系统回顾和meta分析。方法:检索多个数据库,检索2024年12月前发表的随机对照试验,比较PCV、PCV- vg和VCV对Trendelenburg位行腹腔镜手术患者的影响。主要结局包括气道峰值压力(Ppeak)、平台气道压力(Pplat)、动态顺应性(Cdyn)和血气分析。结果:本荟萃分析纳入了16项研究。PCV[峰值,气腹后15 - 40分钟和Trendelenburg位(T2):术中PCV和VCV之间或PCV- vg和VCV之间的平均差值(MD) - 4.28, 95%可信区间(CI) - 5.91至- 2.64,p2、pH和PaO2/FiO2无差异。结论:我们的meta分析表明,在Trendelenburg体位的腹腔镜手术中,PCV或PCV- vg可以在整个手术过程中提供较低的峰值和较高的Cdyn,但不能提供比VCV更好的氧合。PCV或PCV- vg可能是Trendelenburg位腹腔镜手术的最佳选择。
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
自引率
3.80%
发文量
55
审稿时长
10 weeks
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