Ventilación durante cirugía laparoscópica bariátrica. Modos ventilatorios
Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes.
Dion JM1, McKee C, Tobias JD, Sohner P, Herz D, Teich S, Rice J, Barry ND, Michalsky M.
Int J Clin Exp Med. 2014 Aug 15;7(8):2242-7. eCollection 2014.
Abstract
INTRODUCTION: Managing ventilation and oxygenation during laparoscopic procedures in severely obese patients undergoing weight loss surgerypresents many challenges. Pressure-controlled ventilation, volume-guaranteed (PCV-VG) is a dual-control mode of ventilation and an alternative to pressure (PC) or volume (VC) controlled ventilation. PCV-VG features a user-selected tidal volume target, that is auto-regulated and pressure controlled. We hypothesized that PCV-VG ventilation would provide improved oxygenation and ventilation during laparoscopic bariatric surgery with a lower peak inflating pressure (PIP) than either PC or VC ventilation. METHODS: This was a prospective cross-over cohort trial (n = 20). In random sequence each patient received the three modes of ventilation for 20 minutes during the laparoscopic portion of the procedure. For all modes of ventilation the goal tidal volume was 6-8 mL/kg, and the respiratory rate was adjusted to achieve normocarbia. The PIP, exhaled tidal volume, respiratory rate, and oxygen saturation were recorded every five minutes. At the end of 20 minutes, an arterial blood gas was obtained. Data were analyzed using a paired t-test. RESULTS: PCV-VG and PC ventilation both resulted in significantly lower PIP (cmH2O) than VC ventilation (30.5 ± 3.0, 31.6 ± 4.9, and 36.3 ± 3.4 mmHg respectively; p < 0.01 for PCV-VG vs. VC and PC vs. VC). There was no difference in oxygenation (PaO2), ventilation (PaCO2) or hemodynamic variables between the three ventilation modes. CONCLUSIONS: In adolescents and young adults undergoing laparoscopic bariatric surgery, PCV-VG and PC were superior to VC ventilation in their ability to provide ventilation with the lowest PIP.
KEYWORDS: Bariatric surgery; adolescent; arterial blood gas analysis; obesity; ventilation
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161575/pdf/ijcem0007-2242.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes.
Dion JM1, McKee C, Tobias JD, Sohner P, Herz D, Teich S, Rice J, Barry ND, Michalsky M.
Int J Clin Exp Med. 2014 Aug 15;7(8):2242-7. eCollection 2014.
Abstract
INTRODUCTION: Managing ventilation and oxygenation during laparoscopic procedures in severely obese patients undergoing weight loss surgerypresents many challenges. Pressure-controlled ventilation, volume-guaranteed (PCV-VG) is a dual-control mode of ventilation and an alternative to pressure (PC) or volume (VC) controlled ventilation. PCV-VG features a user-selected tidal volume target, that is auto-regulated and pressure controlled. We hypothesized that PCV-VG ventilation would provide improved oxygenation and ventilation during laparoscopic bariatric surgery with a lower peak inflating pressure (PIP) than either PC or VC ventilation. METHODS: This was a prospective cross-over cohort trial (n = 20). In random sequence each patient received the three modes of ventilation for 20 minutes during the laparoscopic portion of the procedure. For all modes of ventilation the goal tidal volume was 6-8 mL/kg, and the respiratory rate was adjusted to achieve normocarbia. The PIP, exhaled tidal volume, respiratory rate, and oxygen saturation were recorded every five minutes. At the end of 20 minutes, an arterial blood gas was obtained. Data were analyzed using a paired t-test. RESULTS: PCV-VG and PC ventilation both resulted in significantly lower PIP (cmH2O) than VC ventilation (30.5 ± 3.0, 31.6 ± 4.9, and 36.3 ± 3.4 mmHg respectively; p < 0.01 for PCV-VG vs. VC and PC vs. VC). There was no difference in oxygenation (PaO2), ventilation (PaCO2) or hemodynamic variables between the three ventilation modes. CONCLUSIONS: In adolescents and young adults undergoing laparoscopic bariatric surgery, PCV-VG and PC were superior to VC ventilation in their ability to provide ventilation with the lowest PIP.
KEYWORDS: Bariatric surgery; adolescent; arterial blood gas analysis; obesity; ventilation
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161575/pdf/ijcem0007-2242.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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