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Comparison of two modes of one-lung ventilation during thoracotomy:pressure controlled (PCV) vs. volume controlled (VCV)

Bauer, C.; Bourlon-Figuet, S.; Hentz, J. G.; Steib, A.; Dupeyron, J. P.

European Journal of Anaesthesiology (EJA): 2001 - Volume 18 - Issue - p 56
Abstracts and Programme: European Society of Anaesthesiologists; 9th Annual Meeting with the Swedish Society of Anaesthesiology; Gothenburg, Sweden, 7-10 April 2001: Respiration
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Anaesthesiology Department, Hôpital Civil, University Hospital Strasbourg, France

Abstract A-195

Background and goal of the study: High peak airway pressures are responsible for acute lung injury in a number of species [1]. PCV is claimed to decrease peak airway pressure (Ppeak) in ARDS patients and during general anaesthesia. One-lung ventilation (OLV), lateral decubitus position and thoracotomy lead to a decrease in the respiratory system compliance and may increase airway pressures. The aim of this prospective study was to compare PCV to VCV in OLV during thoracotomy.

Materials and methods: After informed consent, 40 patients consecutively scheduled for thoracotomy in the lateral decubitus position under general anaesthesia and OLV were enrolled. The double-lumen endotracheal tubes were Broncho-Cath® from Mallinckrodt. The first patients received successively VCV then PCV (n = 20), the next patients received the inverse ventilatory sequence (n = 20). Each patient was his own referee. The ventilatory settings (Kion®, Siemens) were identical between both groups: tidal volume (Vt) at 10 mL kg−1, respiratory rate at 12 C min−1, I/E ratio at 1/1 and end expiratory pressure at 0 cmH2O. After 20 min in each mode, Ppeak (cmH2O), arterial pressure in O2 (PaO2, mmHg), heart rate (hr, beat min−1) and mean arterial pressure (MAP, mmHg) were analysed. Preoperative forced expired volume in 1 s (FEV1) and body mass index (BMI) were registered. Data (mean ± SD) were statistically analysed using a Student test, ANOVA and linear regression. Significance was defined by P < 0.05.

Results: Demographic data were identical in both groups. There was no effect linked to the chronological order of both ventilatory modes. Ppeak was 18 ± 8% (5.83 ± 3.30 cmH2O) lower in the PCV mode when compared to the VCV mode (P < 0.0001). PaO2, MAP and hr were not different in both modes. There was no correlation between FEV1, BMI and the extent of drop of Ppeak in the PCV mode.

Conclusions: when compared to VCV in OLV during thoracotomy, PCV allowed a reduction of 18 ± 8% in Ppeak at the same Vt and without deleterious effects on haemodynamics. This may reflect the environment of gas distribution and lung mechanics generated by the ventilator in the PCV mode. In this way, PCV may be a protective form of one-lung ventilation during anaesthesia for thoracic surgery.

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Reference:

1 Slutsky A, Tremblay L. Am J Respir Crit Care Med 1998; 157: 1721-5.

Section Description

The abstracts published in this supplement have been typeset from camera-ready copies prepared by the authors. Every effort has been made to reproduce faithfully the abstracts as submitted. These abstracts have been prepared in accordance with the requirements of the European Society of Anaesthesiologists and have not been subjected to review nor editing by the European Journal Of Anaesthesiology. However, no responsibility is assumed by the organisers for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of methods, products, instructions or ideas contained in the material herein. Because of the rapid advances in medical sciences, we recommend that independent verification of diagnoses and drug doses should be made.

© 2001 European Society of Anaesthesiology