Lung-protective properties of expiratory flow-initiated pressure-controlled inverse ratio ventilation: A randomised controlled trial

Autor: Minami Saito, Tomio Andoh, Go Hirabayashi, Koichi Maruyama, Sachiko Terayama, Yuki Akihisa
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Vital capacity
Pulmonology
Physiology
Pulmonary Function
Intermittent Positive-Pressure Ventilation
Positive-Pressure Respiration
Hypercapnia
0302 clinical medicine
030202 anesthesiology
Immune Physiology
Medicine and Health Sciences
Medicine
Inverse ratio ventilation
Reproductive System Procedures
Lung
Tidal volume
Aged
80 and over
Innate Immune System
Multidisciplinary
Middle Aged
Radical Prostatectomy
Laboratory Equipment
Exhalation
Breathing
Cardiology
Cytokines
Engineering and Technology
030211 gastroenterology & hepatology
Female
medicine.symptom
Research Article
Adult
medicine.medical_specialty
Adolescent
Science
Immunology
Ventilators
Equipment
Surgical and Invasive Medical Procedures
Respiratory physiology
03 medical and health sciences
Young Adult
Signs and Symptoms
Permissive hypercapnia
Internal medicine
Tidal Volume
Humans
Normocapnia
Respiratory Physiology
Aged
Prostatectomy
Surgical Excision
business.industry
Pulmonary Gas Exchange
Biology and Life Sciences
Molecular Development
Respiration
Artificial
Immune System
Laparoscopy
Clinical Medicine
business
Developmental Biology
Zdroj: PLoS ONE, Vol 15, Iss 12, p e0243971 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: Background Expiratory flow-initiated pressure-controlled inverse ratio ventilation (EF-initiated PC-IRV) reduces physiological dead space. We hypothesised that EF-initiated PC-IRV would be lung protective compared with volume-controlled ventilation (VCV). Methods Twenty-eight men undergoing robot-assisted laparoscopic radical prostatectomy were enrolled in this randomised controlled trial. The EF-initiated PC-IRV group (n = 14) used pressure-controlled ventilation with the volume guaranteed mode. The inspiratory to expiratory (I:E) ratio was individually adjusted by observing the expiratory flow-time wave. The VCV group (n = 14) used the volume control mode with a 1:2 I:E ratio. The Mann–Whitney U test was used to compare differences in the serum cytokine levels. Results There were no significant differences in serum IL-6 between the EF-initiated PC-IRV (median 34 pg ml-1 (IQR 20.5 to 63.5)) and VCV (31 pg ml-1 (24.5 to 59)) groups (P = 0.84). The physiological dead space rate (physiological dead space/expired tidal volume) was significantly reduced in the EF-initiated PC-IRV group as compared with that in the VCV group (0.31 ± 0.06 vs 0.4 ± 0.07; PPP = 0.62). Two patients in the VCV group had permissive hypercapnia with low forced vital capacity (% predicted). Conclusions There were no differences in the lung-protective properties between the two ventilatory strategies. However, EF-initiated PC-IRV reduced physiological dead space rate; thus, it may be useful for reducing the ventilatory volume that is necessary to maintain normocapnia in patients with low forced vital capacity (% predicted) during robot-assisted laparoscopic radical prostatectomy.
Databáze: OpenAIRE
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