Variable volume-controlled ventilation: Did we find the needle in the haystack?

While this may be a promising ventilation modality in a porcine surfactant depleted model [10], not so much in healthy subjects undergoing open abdominal surgery [11], where no differences in pulmonary function tests, atelectasis and proinflammatory mediators (IL6 and IL8) were found when compared t...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2024-10, Vol.97, p.111568, Article 111568
Main Authors: Pedoto, Alessia, El Tahan, Mohamed R.
Format: Article
Language:English
Subjects:
Lungs
Surfactants
Surgical outcomes
Thoracic surgery
Ventilators
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Summary:While this may be a promising ventilation modality in a porcine surfactant depleted model [10], not so much in healthy subjects undergoing open abdominal surgery [11], where no differences in pulmonary function tests, atelectasis and proinflammatory mediators (IL6 and IL8) were found when compared to non-variable ventilation. While these two studies led to clinically negative results, they provide the substrate for a potential larger multicenter randomized controlled study comparing “variable” versus “fixed” VT of 4 to 5 ml/kgIBW in conjunction with frequent regular alveolar recruiting maneuvers, individualized PEEP to the best pulmonary compliance, limiting peak, plateau, and driving pressures, as well as mechanical power. In addition to PPCs, variable of interest may incorporate surgical complications, hospital stay, need for reoperation, unplanned ICU admission and hospital readmission, quality of life, short-and-long-term survival, and tumor recurrence rate.
ISSN:0952-8180
1873-4529
1873-4529
DOI:10.1016/j.jclinane.2024.111568