Effect of volume control ventilation versus pressure control ventilation with volume-guaranteed mode on intraoperative respiratory mechanics and postoperative pulmonary functions in patients undergoing scoliosis surgery: A randomised control trial

Area of Science:

• Anesthesiology
• Respiratory Physiology
• Spinal Surgery

Background:

• Posterior spinal fusion for thoracolumbar scoliosis in the prone position poses significant pulmonary complication risks.
• Pressure-controlled ventilation volume-guaranteed (PCVV) aims to optimize ventilation by regulating inspiratory pressure to achieve target tidal volumes at minimal airway pressure.

Purpose of the Study:

• To compare the efficacy of PCVV against standard volume-guaranteed ventilation (VV) in patients undergoing prone spinal fusion for scoliosis.
• To evaluate the impact of PCVV on pulmonary mechanics, gas exchange, and atelectasis incidence.

Main Methods:

• A randomized controlled trial involving 51 patients with thoracolumbar scoliosis undergoing posterior spinal fusion.
• Patients were allocated to either VV (n=24) or PCVV (n=27) groups.
• Primary endpoints included peak airway pressure (Ppeak), dynamic lung compliance (Cdyn), and arterial blood gas analysis; atelectasis was assessed via lung ultrasonography.

Main Results:

• PCVV significantly reduced Ppeak and improved Cdyn compared to VV.
• PCVV led to lower PaCO2 and reduced the arterial to end-tidal carbon dioxide gradient, indicating improved dead space ventilation.
• Oxygenation, hemodynamic stability, and overall atelectasis scores were similar between the groups.

Conclusions:

• PCVV offers significant benefits in managing pulmonary function during prone spinal fusion surgery for scoliosis.
• The mode enhances airway mechanics and reduces dead space ventilation, potentially mitigating pulmonary complications.