Key result
Volume-guaranteed pressure-controlled ventilation significantly reduced peak airway pressure compared with volume-controlled ventilation during elective surgery (95% CI -3.26 to -1.47; p<0.001).
Why the study?
It was hypothesized that volume-guaranteed or volume-targeted pressure-controlled ventilation could improve airway pressures, dynamic compliance, or arterial blood gases in adults undergoing elective surgery under general anesthesia.
Does PCV-VG improve airway pressures, dynamic compliance, or arterial blood gases compared to VCV in adults undergoing elective surgery under general anesthesia?
Meta-Analysis (n=929)
Does PCV-VG improve airway pressures, dynamic compliance, or arterial blood gases compared to VCV in adults undergoing elective surgery under general anesthesia?
p-value: p=<0.001
PCV-VG provides benefits in airway dynamics and oxygenation compared to VCV during elective surgery under general anesthesia.
Supports PCV-VG to lower peak pressures in elective surgery; confirms meta-analytic advantages over VCV for airway dynamics.
For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.
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Schick et al. (2021) conducted a meta-analysis in Elective surgery under general anesthesia (n=929). Volume-guaranteed or -targeted pressure-controlled ventilation (PCV-VG) vs. Volume-controlled ventilation (VCV) was evaluated on Peak airway pressure (Ppeak) under supine two-lung ventilation (95% CI -3.26 to -1.47, p=<0.001). Volume-guaranteed pressure-controlled ventilation significantly reduced peak airway pressure compared with volume-controlled ventilation during elective surgery (95% CI -3.26 to -1.47; p<0.001).