Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery
Background and Aims: Identifying an ideal intraoperative ventilation strategy remains an area of research. We evaluated the effect of ultrasound-guided–pressure-controlled ventilation (UG-PCV) on the blood-gas and ventilatory parameters, during both two-lung ventilation (TLV) and one-lung ventilatio...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2020;volume=64;issue=12;spage=1047;epage=1053;aulast=Ghosh |
| _version_ | 1818662482046091264 |
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| author | Deyashinee Ghosh Gaurav Jain Ankit Agarwal Nishith Govil |
| author_facet | Deyashinee Ghosh Gaurav Jain Ankit Agarwal Nishith Govil |
| author_sort | Deyashinee Ghosh |
| collection | DOAJ |
| description | Background and Aims: Identifying an ideal intraoperative ventilation strategy remains an area of research. We evaluated the effect of ultrasound-guided–pressure-controlled ventilation (UG-PCV) on the blood-gas and ventilatory parameters, during both two-lung ventilation (TLV) and one-lung ventilation (OLV) for thoracic surgery of unilateral pulmonary disease, compared with volume-targeted PCV (VT-PCV). Methods: In a prospective, parallel-group and double-blinded design, 40 consecutive patients were randomised into two groups. Group A: Received VT-PCV at a tidal volume (TV) of 9 mL/kg for TLV and 5 mL/kg for OLV; group B: Received UG-PCV at an inspiratory pressure (2 cmH2O increments every 15 s) targeted to achieve the alveolar aeration at the base of the dependent lung (ultrasound-guided), for both TLV/OLV, respectively. Primary outcome included arterial oxygen partial pressure (PaO2) measured at baseline before anaesthesia induction (T1), at 30 min immediately before conversion from TLV to OLV (T2), at 30 min on OLV (T3) and before terminating OLV at the end of surgery (T4). Statistical tool included Mann-Whitney test. Results: The PaO2 (mmHg) was significantly higher in group B (374.5 ± 25.9, 321.7 ± 35.2 and 357.0 ± 24.7) as compared to group A (353.3 ± 38.1, 272.6 ± 37.9 and 295.3 ± 40.1), at T2, T3 and T4, respectively. The acid-base status remained preserved in group B, while gradual respiratory acidosis was observed in group A. The bicarbonate levels remained uniform in all patients. The TV and airway pressures were marginally higher in group B, with no intraoperative complications. Conclusion: The UG-PCV mode offered better oxygenation, homogenous acid-base balance and individualised alveolar ventilation for thoracic surgery. |
| first_indexed | 2024-12-17T05:01:39Z |
| format | Article |
| id | doaj.art-1b5d5d75d8c54cb9941eb0d44b3534be |
| institution | Directory Open Access Journal |
| issn | 0019-5049 0976-2817 |
| language | English |
| last_indexed | 2024-12-17T05:01:39Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj.art-1b5d5d75d8c54cb9941eb0d44b3534be2022-12-21T22:02:32ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172020-01-0164121047105310.4103/ija.IJA_548_20Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgeryDeyashinee GhoshGaurav JainAnkit AgarwalNishith GovilBackground and Aims: Identifying an ideal intraoperative ventilation strategy remains an area of research. We evaluated the effect of ultrasound-guided–pressure-controlled ventilation (UG-PCV) on the blood-gas and ventilatory parameters, during both two-lung ventilation (TLV) and one-lung ventilation (OLV) for thoracic surgery of unilateral pulmonary disease, compared with volume-targeted PCV (VT-PCV). Methods: In a prospective, parallel-group and double-blinded design, 40 consecutive patients were randomised into two groups. Group A: Received VT-PCV at a tidal volume (TV) of 9 mL/kg for TLV and 5 mL/kg for OLV; group B: Received UG-PCV at an inspiratory pressure (2 cmH2O increments every 15 s) targeted to achieve the alveolar aeration at the base of the dependent lung (ultrasound-guided), for both TLV/OLV, respectively. Primary outcome included arterial oxygen partial pressure (PaO2) measured at baseline before anaesthesia induction (T1), at 30 min immediately before conversion from TLV to OLV (T2), at 30 min on OLV (T3) and before terminating OLV at the end of surgery (T4). Statistical tool included Mann-Whitney test. Results: The PaO2 (mmHg) was significantly higher in group B (374.5 ± 25.9, 321.7 ± 35.2 and 357.0 ± 24.7) as compared to group A (353.3 ± 38.1, 272.6 ± 37.9 and 295.3 ± 40.1), at T2, T3 and T4, respectively. The acid-base status remained preserved in group B, while gradual respiratory acidosis was observed in group A. The bicarbonate levels remained uniform in all patients. The TV and airway pressures were marginally higher in group B, with no intraoperative complications. Conclusion: The UG-PCV mode offered better oxygenation, homogenous acid-base balance and individualised alveolar ventilation for thoracic surgery.http://www.ijaweb.org/article.asp?issn=0019-5049;year=2020;volume=64;issue=12;spage=1047;epage=1053;aulast=Ghoshblood gas analysismechanical ventilationthoracic surgeryultrasonography |
| spellingShingle | Deyashinee Ghosh Gaurav Jain Ankit Agarwal Nishith Govil Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery Indian Journal of Anaesthesia blood gas analysis mechanical ventilation thoracic surgery ultrasonography |
| title | Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| title_full | Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| title_fullStr | Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| title_full_unstemmed | Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| title_short | Effect of ultrasound-guided–pressure-controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| title_sort | effect of ultrasound guided pressure controlled ventilation on intraoperative blood gas and ventilatory parameters during thoracic surgery |
| topic | blood gas analysis mechanical ventilation thoracic surgery ultrasonography |
| url | http://www.ijaweb.org/article.asp?issn=0019-5049;year=2020;volume=64;issue=12;spage=1047;epage=1053;aulast=Ghosh |
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