Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation.
OBJECTIVE
To test the effects of pressure-controlled (PCV) and volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for thoracic surgery on right ventricular (RV) function.


METHODS
A prospective, randomized, double-blind, controlled, crossover study.


METHODS
A single university hospital.


METHODS
Fourteen pairs of consecutive patients scheduled for elective thoracotomy.


METHODS
Patients were assigned randomly to ventilate the dependent lung with PCV or VCV mode, each in a randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1: 2.5, positive end-expiratory pressure (PEEP) of 5 cm H2O and respiratory rate adjusted to maintain normocapnia.


RESULTS
Intraoperative changes in RV function (systolic and early diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV), end-diastolic volume (EDV) and fractional area changes (FAC)), airway pressures, compliance and oxygenation index were recorded. The use of PCV during OLV resulted in faster systolic (10.1±2.39 vs. 5.8±1.67 cm/s, respectively), diastolic TAV (9.2±1.99 vs. 4.6±1.42 cm/s, respectively) (p<0.001) and compliance and lower ESV, EDV and airway pressures (p<0.05) than during the use of VCV. Oxygenation indices were similar during the use of VCV and PCV.


CONCLUSIONS
The use of PCV offers more improved RV function than the use of VCV during OLV for open thoracotomy. These results apply specifically to younger patients with good ventricular and pulmonary functions.
Department of Cardiology, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Abdullah M
AM
Al Shehri
Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia. Electronic address: mohamedrefaateltahan@yahoo.com.
Mohamed R
MR
El-Tahan
Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Roshdi
R
Al Metwally
Department of Pulmonology and Intensive Care Unit, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Hatem
H
Qutub
Cardiothoracic Surgery, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Yasser F
YF
El Ghoneimy
Cardiothoracic Surgery, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Mohamed A
MA
Regal
Department of Anaesthesia and Surgical ICU, King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia.
Haytham
H
Zien
D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D061810:One-Lung Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D019616:Thoracic Surgical Procedures; D013990:Tidal Volume; D016278:Ventricular Function, Right
Thoracic surgery; one-lung ventilation; pressure-controlled ventilation; right ventricular function.; volume-controlled ventilation