Volume-Controlled Versus Dual-Controlled Ventilation during Robot-Assisted Laparoscopic Prostatectomy with Steep Trendelenburg Position: A Randomized-Controlled Trial

Abstract

Dual-controlled ventilation (DCV) combines the advantages of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Carbon dioxide (CO2) pneumoperitoneum and steep Trendelenburg positioning for robot-assisted laparoscopic radical prostatectomy (RALRP) has negative effects on the respiratory system. We hypothesized that the use of autoflow as one type of DCV can reduce these effects during RALRP. Eighty patients undergoing RALRP were randomly assigned to receive VCV or DCV. Arterial oxygen tension (PaO2) as the primary outcome, respiratory and hemodynamic data, and postoperative fever rates were compared at four time points: 10 min after anesthesia induction (T1), 30 and 60 min after the initiation of CO2 pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after supine positioning (T4). There were no significant differences in PaO2 between the two groups. Mean peak airway pressure (Ppeak) was significantly lower in group DCV than in group VCV at T2 (mean difference, 5.0 cm H2O; adjusted p < 0.001) and T3 (mean difference, 3.9 cm H2O; adjusted p < 0.001). Postoperative fever occurring within the first 2 days after surgery was more common in group VCV (12%) than in group DCV (3%) (p = 0.022). Compared with VCV, DCV did not improve oxygenation during RALRP. However, DCV significantly decreased Ppeak without hemodynamic instability.