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BMC Anesthesiology

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Open Access 01-12-2020 | Research article

Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

Authors: Jonas Weber, Leonie Straka, Silke Borgmann, Johannes Schmidt, Steffen Wirth, Stefan Schumann

Published in: BMC Anesthesiology | Issue 1/2020

Abstract

Background

In obese patients, high closing capacity and low functional residual capacity increase the risk for expiratory alveolar collapse. Constant expiratory flow, as provided by the new flow-controlled ventilation (FCV) mode, was shown to improve lung recruitment. We hypothesized that lung aeration and respiratory mechanics improve in obese patients during FCV.

Methods

We compared FCV and volume-controlled (VCV) ventilation in 23 obese patients in a randomized crossover setting. Starting with baseline measurements, ventilation settings were kept identical except for the ventilation mode related differences (VCV: inspiration to expiration ratio 1:2 with passive expiration, FCV: inspiration to expiration ratio 1:1 with active, linearized expiration). Primary endpoint of the study was the change of end-expiratory lung volume compared to baseline ventilation. Secondary endpoints were the change of mean lung volume, respiratory mechanics and hemodynamic variables.

Results

The loss of end-expiratory lung volume and mean lung volume compared to baseline was lower during FCV compared to VCV (end-expiratory lung volume: FCV, − 126 ± 207 ml; VCV, − 316 ± 254 ml; p < 0.001, mean lung volume: FCV, − 108.2 ± 198.6 ml; VCV, − 315.8 ± 252.1 ml; p < 0.001) and at comparable plateau pressure (baseline, 19.6 ± 3.7; VCV, 20.2 ± 3.4; FCV, 20.2 ± 3.8 cmH₂O; p = 0.441), mean tracheal pressure was higher (baseline, 13.1 ± 1.1; VCV, 12.9 ± 1.2; FCV, 14.8 ± 2.2 cmH₂O; p < 0.001). All other respiratory and hemodynamic variables were comparable between the ventilation modes.

Conclusions

This study demonstrates that, compared to VCV, FCV improves regional ventilation distribution of the lung at comparable PEEP, tidal volume, P_Plat and ventilation frequency. The increase in end-expiratory lung volume during FCV was probably caused by the increased mean tracheal pressure which can be attributed to the linearized expiratory pressure decline.

Trial registration

German Clinical Trials Register: DRKS00014925. Registered 12 July 2018.

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Title: Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial
Authors: Jonas Weber
Leonie Straka
Silke Borgmann
Johannes Schmidt
Steffen Wirth
Stefan Schumann
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-020-0944-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Flow-controlled ventilation (FCV) improves regional ventilation in obese patients – a randomized controlled crossover trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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