Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery

Yu-Ping Wang; Ying Wei; Xiu-Ying Chen; Long-Xin Zhang; Min Zhou; Jing Wang

doi:10.21037/tp-21-421

Comparison between pressure-controlled ventilation with volume-guaranteed mode and volume-controlled mode in one-lung ventilation in infants undergoing video-assisted thoracoscopic surgery

Transl Pediatr. 2021 Oct;10(10):2514-2520. doi: 10.21037/tp-21-421.

Authors

Yu-Ping Wang^{1

2

3}, Ying Wei^{1

2

3}, Xiu-Ying Chen^{1

2

3}, Long-Xin Zhang^{1

2

3}, Min Zhou^{1

2

3}, Jing Wang^{1

2

3}

Affiliations

¹ Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
² Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.
³ Department of Anesthesiology, Fujian Children's Hospital, Fuzhou, China.

Abstract

Background: The appropriate ventilation mode for one-lung ventilation (OLV) in infants undergoing video-assisted thoracoscopic surgery (VATS) remains controversial. Here we investigated the effect of ventilatory mode "pressure-controlled ventilation-volume guaranteed" (PCV-VG) on the airway pressures and oxygenation parameters by comparing it with volume-controlled ventilation (VCV).

Methods: We retrospectively analyzed the clinical data of infants aged 2 to 12 months who underwent extratracheal bronchial blockage for OLV in our center between January 2017 and August 2020. The infants were divided into two groups according to the OLV pattern: group G (n=30, receiving PCV-VG) and group V (n=28, receiving VCV). Mean arterial pressure (MAP), heart rate (HR), maximum inspiratory pressure (P_peak), mean airway pressure (P_mean), dynamic compliance (Cdyn), partial arterial pressure of oxygen (PaO₂) was measured and compared between these two groups 10 min before OLV (T1), 30 min after the onset of OLV (T2) and 15 min after OLV (T3). The possible occurrence of hypoxemia and hypotension during OLV was monitored.

Results: Compared to group V, group G had significantly higher PaO₂and C_dyn (both P<0.05) and significantly lower P_peak and P_mean (both P<0.05) in T2. However, all indicators did not show significant differences between these two groups at T1 and T3 (all P>0.05). The incidence of hypoxemia was significantly higher in group V than in group G (P<0.05), while the difference in the incidence of hypotension was not statistically significant (P>0.05).

Conclusions: Mechanical ventilation using the PCV-VG mode is possible in infants when performing OLV during VATS. Compared to VCV, PCV-VG can offer lower P_peak and P_mean, improve lung compliance, and achieve better oxygenation.

Keywords: One-lung ventilation (OLV); anesthesia; infants; pressure-controlled ventilation with volume-guaranteed.