Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy.
BACKGROUND
The prone position during robotic esophageal mobilization for minimally invasive esophagectomy (MIE) provides several advantages with regards to operative times, surgeon ergonomics, and surgical view; however, this technique requires one-lung ventilation (OLV). There are no guidelines about ventilatory modes during OLV in the prone position. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on oxygenation and intrapulmonary shunt during OLV in the prone position in patients who underwent robot-assisted esophagectomy.


METHODS
Eighteen patients, no major obstructive or restrictive pulmonary disease, were allocated randomly to one of two groups. In the first group (n = 9), OLV was started by VCV and the ventilator was switched to PCV after 30 minutes. In the second group (n = 9), the modes of ventilation were performed in the opposite order in the prone position. Hemodynamic and respiratory variables were obtained during OLV at the end of each ventilatory mode.


RESULTS
There were no significant differences in arterial oxygen tension (PaO(2)), airway pressures, dynamic lung compliance, or physiologic dead space (Vd/Vt) during OLV between PCV and VCV in the prone position. Intrapulmonary shunt (Qs/Qt) was significantly lower with VCV than with PCV during OLV in the prone position (p = 0.044).


CONCLUSIONS
PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robot-assisted esophagectomy and who have normal body mass index and preserved pulmonary function.
Choi
Yong Seon
YS
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, 120-752, Seoul, South Korea. yschoi@yuhs.ac
Shim
Jae Kwang
JK
Na
Sungwon
S
Hong
Seung Bum
SB
Hong
Yong Woo
YW
Oh
Young Jun
YJ
D000704:Analysis of Variance; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011312:Pressure; D016684:Prone Position; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012129:Respiratory Function Tests; D012371:Robotics