Effect of volume control ventilation versus pressure control ventilation with volume-guaranteed mode on intraoperative respiratory mechanics and postoperative pulmonary functions in patients undergoing scoliosis surgery: A randomised control trial.

Abstract

Background: Posterior spinal fusion surgery for thoracolumbar scoliosis in the prone position, places the patient at high risk of pulmonary complications. The pressure-controlled ventilation volume-guaranteed mode regulates the inspiratory pressure limits to achieve a set tidal volume with the lowest airway pressure. We hypothesised that pressure-controlled ventilation volume-guaranteed mode would result in improved pulmonary mechanics, gas exchange and lower incidence of atelectasis than ventilation volume-guaranteed mode in patients undergoing corrective surgery for scoliosis in the prone position.

Methods: Patients of thoracolumbar scoliosis scheduled for posterior spinal fusion surgery were randomly allocated to the ventilation volume-guaranteed (n = 24) or pressure-controlled ventilation volume-guaranteed group (n = 27). As primary endpoints, peak airway pressure (Ppeak), dynamic lung compliance (Cdyn) and arterial blood gas parameters were evaluated at predefined time points. Screening for atelectasis was done by lung ultrasonography on intensive care unit arrival.

Results: Pressure-controlled ventilation volume-guaranteed resulted in significantly reduced Ppeak and Cdyn as well as lower PaCO₂ and arterial to end-tidal carbon dioxide gradient. Both the groups were comparable with regard to oxygenation, hemodynamic variables and total lung ultrasound scores.

Conclusion: Pressure-controlled ventilation volume-guaranteed confers significant advantages like improved airway mechanics and lower dead space ventilation in patients undergoing corrective surgery for scoliosis.