Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis

Authors: Kyu Nam Kim, Dong Won Kim, Mi Ae Jeong, Yeong Hun Sin, Soo Kyung Lee

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

Not only arterial hypoxemia but acute lung injury also has become the major concerns of one-lung ventilation (OLV). The use of pressure-controlled ventilation (PCV) for OLV offers the potential advantages of lower airway pressure and intrapulmonary shunt, which result in a reduced risk of barotrauma and improved oxygenation, respectively.

Methods

We searched Medline, Embase, the Cochrane central register of controlled trials and KoreaMedto find publications comparing the effects of PCV with those of volume-controlled ventilation (VCV) during intraoperative OLV in adults. A meta-analysis of randomized controlled trials was performed using the Cochrane Review Methods.

Results

Six studies (259 participants) were included. The PaO2/FiO2 ratio in PCV was higher than in VCV [weighted mean difference (WMD) = 11.04 mmHg, 95 % confidence interval (CI) = 0.30 to 21.77, P = 0.04, I2 = 3 %] and peak inspiratory pressure was significantly lower in PCV (WMD = −4.91 cm H2O, 95 % CI = −7.30 to –2.53, P < 0.0001, I 2 = 91 %). No differences in PaCO2, tidal volume, heart rate and blood pressure were observed. There were also no differences incompliance, plateau and mean airway pressure.

Conclusions

Our meta-analysis provided the evidence of improved oxygenation in PCV. However, it is difficult to draw any definitive conclusions due to the fact that the duration of ventilation in the studies reviewed was insufficient to reveal clinically relevant benefits or disadvantages of PCV. Significantly lower peak inspiratory pressure is the advantage of PCV.
Appendix
Available only for authorised users
Literature
1.
Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology. 2009;110:1402–11.CrossRefPubMed
2.
Grichnik KP, Clark JA. Pathophysiology and management of one-lung ventilation. Thorac Surg Clin. 2005;15:85–103.CrossRefPubMed
3.
Senturk M. New concepts of the management of one-lung ventilation. Curr Opin Anaesthesiol. 2006;19:1–4.CrossRefPubMed
4.
5.
Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg. 2003;97:1558–65.CrossRef
6.
Jeon K, Yoon JW, Suh GY, Kim J, Kim K, Yang M, et al. Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients. Anaesth Intensive Care. 2009;37:14–9.PubMed
7.
Eguchi T, Yoshida K, Kondo R, Hamanaka K, Shiina T, Komatsu Y, et al. Sivelestat prevents cytoskeletal rearrangements in neutrophils resulting from lung re-expansion following one-lung ventilation during thoracic surgery. Inflammation. 2013;36:1479–84.CrossRefPubMed
8.
Misthos P, Katsaragakis S, Theodorou D, Milingos N, Skottis I. The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study. Eur J Cardiothorac Surg. 2006;29:591–5.CrossRefPubMed
9.
Misthos P, Katsaragakis S, Milingos N, Kakaris S, Sepsas E, Athanassiadi K, et al. Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation. Eur J Cardiothorac Surg. 2005;27:379–82. discussion 82–3.CrossRefPubMed
10.
Funakoshi T, Ishibe Y, Okazaki N, Miura K, Liu R, Nagai S, et al. Effect of re-expansion after short-period lung collapse on pulmonary capillary permeability and pro-inflammatory cytokine gene expression in isolated rabbit lungs. Br J Anaesth. 2004;92:558–63.CrossRefPubMed
11.
Brodsky JB, Fitzmaurice B. Modern anesthetic techniques for thoracic operations. World J Surg. 2001;25:162–6.CrossRefPubMed
12.
Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010;14:R1.CrossRefPubMedPubMedCentral
13.
Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O. What tidal volumes should be used in patients without acute lung injury? Anesthesiology. 2007;106:1226–31.CrossRefPubMed
14.
Ishikawa S, Lohser J. One-lung ventilation and arterial oxygenation. Curr Opin Anaesthesiol. 2011;24:24–31.CrossRefPubMed
15.
Della Rocca G, Coccia C. Ventilatory management of one-lung ventilation. Minerva Anestesiol. 2011;77:534–6.PubMed
16.
Shelley B, Macfie A, Kinsella J. Anesthesia for thoracic surgery: a survey of UK practice. J Cardiothorac Vasc Anesth. 2011;25:1014–7.CrossRefPubMed
17.
Senturk NM, Dilek A, Camci E, Senturk E, Orhan M, Tugrul M, et al. Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation. J Cardiothorac Vasc Anesth. 2005;19:71–5.CrossRefPubMed
18.
Tugrul M, Camci E, Karadeniz H, Senturk M, Pembeci K, Akpir K. Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia. Br J Anaesth. 1997;79:306–10.CrossRefPubMed
19.
Heimberg C, Winterhalter M, Struber M, Piepenbrock S, Bund M. Pressure-controlled versus volume-controlled one-lung ventilation for MIDCAB. Thorac Cardiovasc Surg. 2006;54:516–20.CrossRefPubMed
20.
Kang WS, Kim SH, Woo CJ. Comparison of Pulmonary Gas Exchange According to Intraoperative Ventilation Modes for Mitral Valve Repair Surgery via Thoracotomy With One-Lung Ventilation: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2014;28:920–5.CrossRef
21.
Montes FR, Pardo DF, Charris H, Tellez LJ, Garzon JC, Osorio C. Comparison of two protective lung ventilatory regimes on oxygenation during one-lung ventilation: a randomized controlled trial. J Cardiothorac Surg. 2010;5:99.CrossRefPubMedPubMedCentral
22.
23.
24.
Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.CrossRefPubMed
25.
Curtin F, Elbourne D, Altman DG. Meta-analysis combining parallel and cross-over clinical trials. III: The issue of carry-over. Stat Med. 2002;21:2161–73.CrossRefPubMed
26.
Pardos PC, Garutti I, Pineiro P, Olmedilla L, de la Gala F. Effects of ventilatory mode during one-lung ventilation on intraoperative and postoperative arterial oxygenation in thoracic surgery. J Cardiothorac Vasc Anesth. 2009;23:770–4.CrossRefPubMed
27.
Eren Ongur F, Erolcay H, Yuceyar L, Sayilgan C, Ongur M, Demirkaya A. The comparison of the effects of volume vs pressure controlled ventilation on recruitment maneuver during one lung ventilation. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 2010;16:16–22.
28.
Unzueta MC, Casas JI, Moral MV. Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery. Anesth Analg. 2007;104:1029–33. tables of contents.CrossRefPubMed
29.
Al Shehri AM, El-Tahan MR, Al Metwally R, Qutub H, El Ghoneimy YF, Regal MA, et al. Right ventricular function during one-lung ventilation: effects of pressure-controlled and volume-controlled ventilation. J Cardiothorac Vasc Anesth. 2014;28:892–6.CrossRef
30.
Campbell RS, Davis BR. Pressure-controlled versus volume-controlled ventilation: does it matter? Respir Care. 2002;47:416–24. discussion 24–6.PubMed
31.
32.
33.
Al-Saady N, Bennett ED. Decelerating inspiratory flow waveform improves lung mechanics and gas exchange in patients on intermittent positive-pressure ventilation. Intensive Care Med. 1985;11:68–75.CrossRefPubMed
34.
Prella M, Feihl F, Domenighetti G. Effects of short-term pressure-controlled ventilation on gas exchange, airway pressures, and gas distribution in patients with acute lung injury/ARDS: comparison with volume-controlled ventilation. Chest. 2002;122:1382–8.CrossRefPubMed
35.
Marini JJ, Ravenscraft SA. Mean airway pressure: physiologic determinants and clinical importance--Part 1: Physiologic determinants and measurements. Crit Care Med. 1992;20:1461–72.CrossRef
36.
Unzueta C, Tusman G, Suarez-Sipmann F, Bohm S, Moral V. Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial. Br J Anaesth. 2012;108:517–24.CrossRefPubMed
37.
Tusman G, Bohm SH, Sipmann FS, Maisch S. Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung ventilation anesthesia. Anesth Analg. 2004;98:1604–9. table of contents.CrossRefPubMed
38.
Esteban A, Alia I, Gordo F, de Pablo R, Suarez J, Gonzalez G, et al. Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group. Chest. 2000;117:1690–6.CrossRefPubMed
39.
Kallet RH, Campbell AR, Dicker RA, Katz JA, Mackersie RC. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respir Care. 2005;50:1623–31.PubMed
40.
Fujita Y, Fujino Y, Uchiyama A, Mashimo T, Nishimura M. High peak inspiratory flow can aggravate ventilator-induced lung injury in rabbits. Med Sci Monit. 2007;13:BR95–100.PubMed
41.
Benumof JL. One-lung ventilation and hypoxic pulmonary vasoconstriction: implications for anesthetic management. Anesth Analg. 1985;64:821–33.CrossRefPubMed
42.
Saito T, Den S, Cheema SP, Tanuma K, Carney E, Carlsson C, et al. A single-injection, multi-segmental paravertebral block-extension of somatosensory and sympathetic block in volunteers. Acta Anaesthesiol Scand. 2001;45:30–3.CrossRefPubMed
43.
Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia. 1995;50:118–21.CrossRefPubMed
44.
Garutti I, Quintana B, Olmedilla L, Cruz A, Barranco M, Garcia de Lucas E. Arterial oxygenation during one-lung ventilation: combined versus general anesthesia. Anesth Analg. 1999;88:494–9.CrossRefPubMed
45.
46.
Slinger P. Pro: low tidal volume is indicated during one-lung ventilation. Anesth Analg. 2006;103:268–70.CrossRefPubMed
47.
Boussarsar M, Thierry G, Jaber S, Roudot-Thoraval F, Lemaire F, Brochard L. Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intensive Care Med. 2002;28:406–13.CrossRefPubMed
48.
Michelet P, D’Journo XB, Roch A, Doddoli C, Marin V, Papazian L, et al. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology. 2006;105:911–9.CrossRefPubMed
49.
Licker M, Diaper J, Villiger Y, Spiliopoulos A, Licker V, Robert J, et al. Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery. Crit Care. 2009;13:R41.CrossRefPubMedPubMedCentral
50.
Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 2001;135:982–9.CrossRefPubMed
51.
Slinger P, Scott WA. Arterial oxygenation during one-lung ventilation. A comparison of enflurane and isoflurane. Anesthesiology. 1995;82:940–6.CrossRefPubMed
Metadata
Title
Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis
Authors
Kyu Nam Kim
Dong Won Kim
Mi Ae Jeong
Yeong Hun Sin
Soo Kyung Lee
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-016-0238-6

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Research article

Teaching basic lung isolation skills on human anatomy simulator: attainment and retention of lung isolation skills

Research article

Dexmedetomidine versus remifentanil for sedation during awake intubation using a Shikani optical stylet: a randomized, double-blinded, controlled trial

Research article

Head elevation by 3 vs. 6 cm in ProSeal laryngeal mask airway insertion: a randomized controlled trial

Research article

A randomized prospective controlled trial comparing the laryngeal tube suction disposable and the supreme laryngeal mask airway: the influence of head and neck position on oropharyngeal seal pressure

Research article

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

Research article

Correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy