Jing Shi, Wenjuan Bao, Wenjing Chen, Xiang Liu, Lei Shi, Hongyan Wang
In young children undergoing prolonged laparoscopic surgery, PRVC lowered Ppeak and Pmean but did not reduce Pplat or ΔP, suggesting similar alveolar distention to that occurring in VCV. Both modes maintained adequate ventilation and stable hemodynamics. PRVC may improve airway pressure profiles, but its routine replacement with VCV should not rely on Ppeak reduction alone.
INTRODUCTION: Optimal ventilation during pediatric laparoscopic surgery is a debated issue, as pneumoperitoneum impairs respiratory mechanics and may increase ventilator-induced lung injury.
AIM: We aimed to compare pressure-regulated volume control (PRVC) and volume-controlled ventilation (VCV) in young children, focusing on airway pressures and gas exchange.
MATERIALS AND METHODS: A total of 120 children aged 1-3 years undergoing elective laparoscopic surgery (≥120 min) were enrolled and assigned to the PRVC or VCV groups. The primary outcome was peak inspiratory pressure (Ppeak) at 30 minutes after pneumoperitoneum. Secondary outcomes included mean airway (Pmean), plateau (Pplat), and driving pressures (ΔP), partial pressure of end-tidal carbon dioxide (PETCO2), arterial carbon dioxide partial pressure (PaCO2), hemodynamics, PaCO2-PETCO2 Bland-Altman agreement, and complication rates.
RESULTS: At 30 minutes, PRVC produced lower mean (SD) Ppeak than VCV (22.67 [4.18] vs 26.24 [4.51] cm H2O; P <0.001) and lower mean Pmean at multiple time points. However, Pplat and ΔP did not differ between the groups. The arterial-to-end-tidal CO2 gradient was wider with PRVC at 30 minutes and after desufflation. Hemodynamic variables remained stable and similar between the groups. The Bland-Altman analysis showed acceptable agreement between PaCO2 and PETCO2 in both modes, with mean (SD) bias of 3.21 (0.48) in the PRVC and 1.91 (0.82) in the VCV cohorts. The complication rates were similar in both groups.
CONCLUSIONS: In young children undergoing prolonged laparoscopic surgery, PRVC lowered Ppeak and Pmean but did not reduce Pplat or ΔP, suggesting similar alveolar distention to that occurring in VCV. Both modes maintained adequate ventilation and stable hemodynamics. PRVC may improve airway pressure profiles, but its routine replacement with VCV should not rely on Ppeak reduction alone.