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Equal Ratio Ventilation Reduces Blood Loss During Posterior Lumbar Interbody Fusion Surgery

 Hye Bin Kim  ;  Tae Dong Kweon  ;  Chul Ho Chang  ;  Ji Young Kim  ;  Kyung Sub Kim  ;  Ji Young Kim 
 SPINE, Vol.46(16) : E852-E858, 2021-08 
Journal Title
Issue Date
Blood Loss, Surgical / prevention & control ; Humans ; Lumbar Vertebrae / surgery ; Lumbosacral Region* ; Prone Position ; Prospective Studies ; Respiratory Mechanics ; Spinal Fusion* / adverse effects
Study design: A prospective randomized double-blinded study.

Objective: The aim of this study was to compare the effect of two different ventilator modes (inspiratory to expiratory ratio [I:E ratio] of 1:1 and 1:2) on intraoperative surgical bleeding in patients undergoing posterior lumbar interbody fusion (PLIF) surgery.

Summary of background data: During PLIF surgery, a considerable amount of blood loss is anticipated. In the prone position, engorgement of the vertebral vein increases surgical bleeding. We hypothesized that equal ratio ventilation (ERV) with I:E ratio of 1:1 would lower peak inspiratory pressure (PIP) in the prone position and consequentially decrease surgical bleeding.

Methods: Twenty-eight patients were randomly assigned to receive either ERV (ERV group, n = 14) or conventional ventilation with I:E ratio of 1:2 (control group, n = 14). Hemodynamic and respiratory parameters were measured at 5 minutes after anesthesia induction, at 5 minutes after the prone position, at the time of skin closure, and at 5 minutes after turning to the supine position.

Results: The amount of intraoperative surgical bleeding in the ERV group was significantly less than that in the control group (975.7 ± 349.9 mL vs. 1757.1 ± 1172.7 mL, P = 0.030). Among other hemodynamic and respiratory parameters, PIP and plateau inspiratory pressure (Pplat) were significantly lower and dynamic lung compliance (Cdyn) was significantly higher in the ERV group than those of the control group throughout the study period, respectively (all P < 0.05).

Conclusion: Compared to conventional ratio ventilation, ERV provided lower PIP and reduced intraoperative surgical blood loss in patients undergoing PLIF surgery.Level of Evidence: 2.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kweon, Tae Dong(권태동) ORCID logo https://orcid.org/0000-0002-5451-1856
Kim, Ji Young(김지영) ORCID logo https://orcid.org/0000-0001-5822-0338
Kim, Hye Bin(김혜빈) ORCID logo https://orcid.org/0000-0003-3108-8693
Chang, Chul Ho(장철호) ORCID logo https://orcid.org/0000-0001-5647-8298
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