Comparison of effects of volume-controlled and pressure-controlled mode of ventilation on endotracheal cuff pressure and respiratory mechanics in laparoscopic cholecystectomies: A randomised controlled trial

• Published in: Indian journal of anaesthesia 2020-10, Vol.64 (10), p.842-848
• Main Authors: Nethra, S, Nagaraja, Swathi, Sudheesh, K, Duggappa, Devika, Sanket, Bhargavi
• Format: Article
• Language: English
• Subjects: Cholecystectomy; Comparative analysis; endotracheal tube cuff pressure; laparoscopic surgery; Laparoscopy; Mechanics; Medical research; Original; Pantoprazole; respiratory mechanicskey messages; Vecuronium
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.IJA_949_19

Background and Aims: One of the pathophysiological consequences of pneumoperitoneum is variations in endotracheal cuff pressure (ETTc). Volume-controlled mode and pressure-controlled mode of ventilation being two modes of ventilatory strategies; we intended to find out variations in ETTc governed by respiratory mechanics between these two modes during laparoscopic cholecystectomies. Methods: After obtaining ethics committee approval, this randomised (1:1), active-controlled, parallel-assigned study was done on 60 patients undergoing laparoscopic cholecystectomies. These patients were allocated into two groups by computer-generated randomisation: Volume-controlled mode (V) and pressure-controlled mode (P). We observed for variations in ETTc which was the primary aim and haemodynamic parameters; respiratory mechanics at baseline (T1), at pneumoperitoneum (T2), after 10 min (T3), 20 min (T4) of pneumoperitoneum and at desufflation (T5). Post-operative laryngotracheal co-morbidities were also observed. Analysis was done using Statistical Package for the Social Sciences version 16.0 (IBM SPSS Statistics, Somers NY, USA). Results: No statistically significant difference was found in both groups either concerning ETTc, haemodynamic parameters or complications. In both groups, ETTc variation was statistically significant when compared from baseline to desufflation (T1 versus T5) and in group V additionally from baseline to time of pneumoperitoneum (T1 versus T2). Group P showed lower peak airway pressure at desufflation and higher mean airway pressure throughout at all the time intervals. Conclusions: There is no variation in ETTc between the two modes. Group P appears to be better in terms of lower Ppeak and better Pmean.