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Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients

Luc De Baerdemaeker UGent, C. Van der Herten, MARC GILLARDIN JEAN UGent, Piet Pattyn UGent, Eric Mortier UGent and Laszlo L Szegedi UGent (2008) Obesity Surgery. 18(6). p.680-685
abstract
Background There are no guidelines on ventilation modes in morbidly obese patients. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on gas exchange, respiratory mechanics, and cardiovascular responses in laparoscopic gastric banding procedures. Methods After Institutional Review Board approval, 24 adult consenting patients scheduled for laparoscopic gastric banding were studied. Anesthesia was standardized using remifentanil, propofol, rocuronium, and sevoflurane. All patients started with VCV with a tidal volume of 10 ml kg(-1) ideal body weight, respiratory rate adjusted to obtain an end-tidal carbon dioxide of 35-40 mmHg, positive end-expiratory pressure of 5 cmH(2)O, an inspiratory pause of 10% and an inspiratory/expiratory ratio of 1:2. Fifteen minutes after pneumoperitoneum, the patients were randomly allocated to two groups. In Group VCV (n=12), ventilation was with the same parameters. In Group PCV (n=12), the airway pressure was set to provide a tidal volume of 10 ml kg(-1) ideal body weight without exceeding 35 cm H2O. Respiratory rate was adjusted to keep an end-tidal carbon dioxide of 35-40 mmHg. Arterial blood samples were drawn after surgical positioning and 15 min after allocation. Analysis of variance (ANOVA) was used for statistical analysis. Results With constant minute ventilation, VCV generates equal airway pressures and cardiovascular effects with a lower Pa-CO2 as compared to PCV (42.5 (5.2) mmHg versus 48.9 (4.3) mmHg, p < 0.01 ANOVA). Arterial oxygenation remained unchanged. Conclusion VCV and PCV appear to be an equally suited ventilatory technique for laparoscopic procedures in morbidly obese patients. Carbon dioxide elimination is more efficient when using VCV.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
GAS-EXCHANGE, TIDAL VOLUME, RESPIRATORY-DISTRESS-SYNDROME, effects, INVERSE RATIO VENTILATION, cardiovascular system, elimination, carbon dioxide, partial pressure oxygen, laparoscopy, surgery, ventilation, mechanics, DEAD SPACE, I/E RATIOS, OXYGENATION, MECHANICS, SURGERY, ANESTHESIA
journal title
Obesity Surgery
Obes. Surg.
volume
18
issue
6
pages
680 - 685
publisher
Springer
place of publication
233 SPRING ST, NEW YORK, NY 10013 USA
conference name
Euroanaesthesia 2005 Meeting
conference location
Vienna, AUSTRIA,
conference start
2005-05-28
conference end
2005-05-31
Web of Science type
Proceedings Paper
Web of Science id
000255631000011
JCR category
SURGERY
JCR impact factor
2.913 (2008)
JCR rank
23/148 (2008)
JCR quartile
1 (2008)
ISSN
0960-8923
DOI
10.1007/s11695-007-9376-8
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
528897
handle
http://hdl.handle.net/1854/LU-528897
date created
2009-03-24 09:39:13
date last changed
2009-03-26 09:37:31
@article{528897,
  abstract     = {Background There are no guidelines on ventilation modes in morbidly obese patients. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on gas exchange, respiratory mechanics, and cardiovascular responses in laparoscopic gastric banding procedures.
Methods After Institutional Review Board approval, 24 adult consenting patients scheduled for laparoscopic gastric banding were studied. Anesthesia was standardized using remifentanil, propofol, rocuronium, and sevoflurane. All patients started with VCV with a tidal volume of 10 ml kg(-1) ideal body weight, respiratory rate adjusted to obtain an end-tidal carbon dioxide of 35-40 mmHg, positive end-expiratory pressure of 5 cmH(2)O, an inspiratory pause of 10\% and an inspiratory/expiratory ratio of 1:2. Fifteen minutes after pneumoperitoneum, the patients were randomly allocated to two groups. In Group VCV (n=12), ventilation was with the same parameters. In Group PCV (n=12), the airway pressure was set to provide a tidal volume of 10 ml kg(-1) ideal body weight without exceeding 35 cm H2O. Respiratory rate was adjusted to keep an end-tidal carbon dioxide of 35-40 mmHg. Arterial blood samples were drawn after surgical positioning and 15 min after allocation. Analysis of variance (ANOVA) was used for statistical analysis.

Results With constant minute ventilation, VCV generates equal airway pressures and cardiovascular effects with a lower Pa-CO2 as compared to PCV (42.5 (5.2) mmHg versus 48.9 (4.3) mmHg, p {\textlangle} 0.01 ANOVA). Arterial oxygenation remained unchanged.

Conclusion VCV and PCV appear to be an equally suited ventilatory technique for laparoscopic procedures in morbidly obese patients. Carbon dioxide elimination is more efficient when using VCV.},
  author       = {De Baerdemaeker, Luc and Van der Herten, C. and GILLARDIN JEAN, MARC and Pattyn, Piet and Mortier, Eric and Szegedi, Laszlo L},
  issn         = {0960-8923},
  journal      = {Obesity Surgery},
  keyword      = {GAS-EXCHANGE,TIDAL VOLUME,RESPIRATORY-DISTRESS-SYNDROME,effects,INVERSE RATIO VENTILATION,cardiovascular system,elimination,carbon dioxide,partial pressure oxygen,laparoscopy,surgery,ventilation,mechanics,DEAD SPACE,I/E RATIOS,OXYGENATION,MECHANICS,SURGERY,ANESTHESIA},
  language     = {eng},
  location     = {Vienna, AUSTRIA,},
  number       = {6},
  pages        = {680--685},
  publisher    = {Springer},
  title        = {Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients},
  url          = {http://dx.doi.org/10.1007/s11695-007-9376-8},
  volume       = {18},
  year         = {2008},
}

Chicago
De Baerdemaeker, Luc, C. Van der Herten, MARC GILLARDIN JEAN, Piet Pattyn, Eric Mortier, and Laszlo L Szegedi. 2008. “Comparison of Volume-controlled and Pressure-controlled Ventilation During Laparoscopic Gastric Banding in Morbidly Obese Patients.” Obesity Surgery 18 (6): 680–685.
APA
De Baerdemaeker, L., Van der Herten, C., GILLARDIN JEAN, M., Pattyn, P., Mortier, E., & Szegedi, L. L. (2008). Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients. Obesity Surgery, 18(6), 680–685. Presented at the Euroanaesthesia 2005 Meeting.
Vancouver
1.
De Baerdemaeker L, Van der Herten C, GILLARDIN JEAN M, Pattyn P, Mortier E, Szegedi LL. Comparison of volume-controlled and pressure-controlled ventilation during laparoscopic gastric banding in morbidly obese patients. Obesity Surgery. 233 SPRING ST, NEW YORK, NY 10013 USA: Springer; 2008;18(6):680–5.
MLA
De Baerdemaeker, Luc, C. Van der Herten, MARC GILLARDIN JEAN, et al. “Comparison of Volume-controlled and Pressure-controlled Ventilation During Laparoscopic Gastric Banding in Morbidly Obese Patients.” Obesity Surgery 18.6 (2008): 680–685. Print.