Abstract
Objective:
To evaluate respiratory and hemodynamic variables in patients receiving volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) during laparoscopic surgeries.
Methods:
Sixty ASA grade I–II patients, aged 18–60 years, with a body mass index (BMI) under 30, scheduled for elective laparoscopic procedures, were enrolled. Group A was sustained on VCV, but Group B transitioned to PCV after 15 min of VCV. Ventilation parameters were established with a tidal volume of 6 mL/kg, a respiratory rate of 12 breaths per minute, and a PEEP of 5 cm H₂O. Hemodynamic and respiratory parameters (systolic and diastolic blood pressure (SBP, DBP), MAP, heart rate (HR), oxygen saturation (SpO₂), capnography (EtCO₂), and peak airway pressure (Ppeak)) were documented at intervals of 15 min.
Results:
Group A exhibited markedly elevated heart rate and mean arterial pressure (MAP) at multiple intervals (P < 0.05). EtCO₂ levels were comparable between groups, except upon extubation, where Group B exhibited lower levels. Ppeak levels were significantly elevated with VCV after 30 min (P < 0.001).
Conclusion:
PCV demonstrated reduced lower airway pressures and enhanced hemodynamic stability relative to VCV in non-obese ASA I–II individuals.
KEYWORDS: Hemodynamic, pneumoperitoneum, pressure-controlled ventilation, volume-controlled ventilation
INTRODUCTION
Laparoscopic surgeries are increasingly employed as they promote healing, reduce hospital stays, and minimize post-operative pain.[1] During surgery, carbon dioxide (CO2) is insufflated into the abdominal cavity to establish pneumoperitoneum, enhancing the operating field and ensuring visualization. Pneumoperitoneum induces considerable physiological alterations, particularly in the cardiorespiratory system, characterized by elevated partial pressure of carbon dioxide (PCO2), acidosis, and hemodynamic instability.[2,3,4] Limited research has demonstrated favorable outcomes with pressure-controlled ventilation (PCV), in contrast to traditional volume-controlled ventilation (VCV).[5,6,7,8] Consequently, we choose to investigate the impact of two distinct modalities of mechanical ventilation on hemodynamic and respiratory parameters in patients undergoing elective laparoscopic procedures.
MATERIAL AND METHODS
This prospective study involved 60 ASA I–II patients, aged 18 to 60 years, with a BMI under 30, undertaking elective laparoscopic surgeries. Following informed consent, regular monitoring was implemented, encompassing heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), oxygen saturation (SpO₂), capnography (EtCO₂), and electrocardiography (ECG).
After 15 min, patients were randomized: Group A persisted with VCV, whereas Group B transitioned to PCV, modifying inspiratory pressure to attain equivalent tidal volume and EtCO₂ targets.
Hemodynamic and respiratory variables (HR, SBP, DBP, MAP, end-tidal carbon dioxide, and peak airway pressure (Ppeak)) were documented at baseline, during pneumoperitoneum, and every 15 min thereafter for a duration of 90 min, encompassing extubation.
Statistical analysis
The continuous variables were presented as mean ± standard deviation (SD) and evaluated using the independent t-test. A P-value less than 0.05 was taken to be statistically significant.
RESULTS
Participants were recruited by screening patients scheduled for laparoscopic surgery. A total of 82 patients underwent screening, and 60 patients who satisfied the inclusion criterion were enrolled in the study. Patients were randomly allocated to either Group A (administered VCV) or Group B (administered PCV).
The present study showed slightly raised heart rate values for the Group A method compared to Group B. The difference was significant (P < 0.05) except for baseline initial VCV and at 90 min after CV. SBP was seen slightly higher at various intervals of time in Group A compared to Group B.
Ppeak values exhibited substantial differences between groups at various time intervals, with Group A demonstrating elevated values from 30 min onwards (P < 0.001). The results are encapsulated in Table 1 and depicted in Figure 1.
Table 1.
Comparison of peak airway pressure (ppeak) values among study groups at different intervals of time
| Name | n | Mean | Std. deviation | P | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 5 MIN After Initial VCV | GROUP-(A) | 30 | 27.67 | 0.479 | 0.081 | |||||
| GROUP-(B) | 30 | 28.00 | 0.910 | |||||||
| 10 MIN after initial VCV (5 min after Pneumoperitoneum) | GROUP-(A) | 30 | 28.30 | 0.466 | 0.154 | |||||
| GROUP-(B) | 30 | 28.60 | 1.037 | |||||||
| 15 MIN AFTER INITIAL VCV | GROUP-(A) | 30 | 27.63 | 1.217 | 0.834 | |||||
| GROUP-(B) | 30 | 27.60 | 1.221 | |||||||
| 30 MIN AFTER CV | GROUP-(A) | 30 | 30.00 | 0.788 | <0.001 | |||||
| GROUP-(B) | 30 | 27.00 | 0.910 | |||||||
| 45 MIN AFTER CV | GROUP-(A) | 30 | 29.97 | 0.809 | <0.001 | |||||
| GROUP-(B) | 30 | 26.60 | 0.814 | |||||||
| 60 MIN AFTER CV | GROUP-(A) | 30 | 28.63 | 0.490 | <0.001 | |||||
| GROUP-(B) | 30 | 26.60 | 0.814 | |||||||
| 75 MIN AFTER CV | GROUP-(A) | 30 | 28.27 | 0.980 | <0.001 | |||||
| GROUP-(B) | 30 | 26.60 | 0.498 | |||||||
| 90 MIN AFTER CV | GROUP-(A) | 30 | 26.63 | 0.490 | 0.016 | |||||
| GROUP-(B) | 30 | 27.00 | 0.643 | |||||||
| EXTUBATION | GROUP-(A) | 30 | 27.63 | 1.217 | 0.9224 | |||||
| GROUP-(B) | 30 | 27.60 | 1.221 |
VCV: Volume-controlled ventilation
Figure 1.
Peak inspiratory pressures (P peak measured in cm H₂O) at different time intervals in Group A (VCV) and Group B (PCV) P peak: Peak airway pressure; VCV: Volume-controlled ventilation; PCV: Pressure-controlled ventilation
DISCUSSION
This research analyzed airway pressures in VCV against PCV during laparoscopic surgery. No substantial variations were seen across groups in the initial 15 min. After pneumoperitoneum, airway pressures were considerably elevated in the VCV group relative to the PCV group between 30 and 75 min (P < 0.001). At 90 min post-extubation, the variations were negligible but were not clinically significant.
The results align with Tyagi et al.,[9] who showed that PCV resulted in significantly reduced peak inspiratory pressures compared to VCV during laparoscopic cholecystectomy, while ensuring sufficient ventilation. Martínez-Leyva et al.[10] similarly observed enhanced dynamic compliance and decreased airway pressures with PCV, especially in obese patients receiving laparoscopic surgeries. Both studies endorse the efficacy of PCV in mitigating airway pressures when pneumoperitoneum impairs pulmonary mechanics.
Sun et al.[11] observed no significant variations in oxygenation between PCV and VCV, indicating that although PCV lowers peak pressures, gas exchange remained similar. This corresponds with our observation that oxygenation measures were not negatively impacted in either group. Oğurlu et al.[7] noticed temporal fluctuations in compliance under PCV, which may elucidate the minor, non-significant increase in pressures recorded in Group B at 90 min.
In conclusion, PCV significantly decreases intraoperative airway pressures during pneumoperitoneum while maintaining adequate ventilation and oxygenation, rendering it a safer and more advantageous option for extended laparoscopic procedures.
CONCLUSION
Our data indicate that PCV yielded superior outcomes following pneumoperitoneum, exhibiting substantially lower peak airway pressures and enhanced management of end-tidal CO₂ in comparison to volume-controlled breathing. While both modalities ensured oxygenation, PCV provided superior respiratory and hemodynamic stability, indicating it as the encouraged method.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors express their sincere gratitude to the surgical and anesthesia teams of Gandhi Medical College, Bhopal, and Clearmedi Paridhi Multispecialty Hospital, Gwalior, for their invaluable support in the conduct of this study. We also thank all the patients who consented to participate.
Funding Statement
Nil.
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