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The effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation

Authors
 Jo, Youn Yi  ;  Kim, Ji Young  ;  Kwak, Young Lan  ;  Kim, Yong Beom  ;  Kwak, Hyun Jeong 
Citation
 JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, Vol.24(1) : 14-18, 2012 
Journal Title
JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY
ISSN
 0898-4921 
Issue Date
2012
MeSH
Adult ; Anesthesia, General ; Blood Gas Analysis ; Female ; Hemodynamics/physiology ; Humans ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Monitoring, Intraoperative ; Oxygen Consumption/physiology ; Positive-Pressure Respiration ; Preanesthetic Medication ; Prone Position ; Prospective Studies ; Respiration, Artificial/methods* ; Respiratory Dead Space ; Respiratory Function Tests ; Respiratory Mechanics/physiology* ; Spine/surgery* ; Supine Position ; Tidal Volume/physiology ; Treatment Outcome
Keywords
prone position ; pressure-controlled ventilation ; volume-controlled ventilation
Abstract
BACKGROUND: When an anesthetized patient is turned to the prone position using the Wilson frame, dynamic compliance (Cdyn) decreases and peak airway pressure (Ppeak) increases. As pressure-controlled ventilation (PCV) decreases the Ppeak, this prospective, randomized study was designed to compare the effect of PCV and volume-controlled ventilation (VCV) on lung mechanics in the prone position using the Wilson frame during posterior lumbar spine surgery.

METHODS: Forty patients scheduled for posterior lumbar spine surgery were randomly allocated to receive mechanical ventilation using either the VCV (n=20) or PCV (n=20) mode. Respiratory variables (including Ppeak and Cdyn) and oxygenation parameters were recorded at the supine position (Tsupine) and 30 minutes after prone positioning (Tprone).

RESULTS: During the study period, tidal volume, minute volume, end-tidal carbon dioxide tension, and positive end-expiratory pressure were comparable between the 2 groups. The Ppeak in the PCV group was lower than that in the VCV group throughout the study period (P=0.007 and 0.003 at Tsupine and Tprone, respectively) and was increased at Tprone compared with Tsupine in both groups. Cdyn was decreased from Tsupine to Tprone in both groups. However, the Cdyn in the PCV group was higher than that in the VCV group during the study period. The arterial oxygen tension was comparable between the 2 groups during the study period.

CONCLUSIONS: PCV provides lower Ppeak compared with VCV when the ventilator is set to deliver the same tidal volume and variable respiratory rate to maintain a constant end-tidal carbon dioxide tension in patients undergoing posterior lumbar spine surgery in the prone position using the Wilson frame.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00008506-201201000-00004&LSLINK=80&D=ovft
DOI
21897297
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Ji Young(김지영) ORCID logo https://orcid.org/0000-0001-5822-0338
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/91007
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