Effect of pressure- versus volume-controlled ventilation on the ventilatory and hemodynamic parameters during laparoscopic appendectomy in children: a prospective, randomized study.

Abstract

BACKGROUND: Several ventilatory strategies have been introduced to minimize the respiratory and hemodynamic effects of carbon dioxide pneumoperitoneum during laparoscopic surgery. The purpose of this study was to compare the effects of pressure-controlled ventilation (PCV) with that of volume-controlled ventilation (VCV) on the ventilatory and hemodynamic parameters in children undergoing laparoscopic appendectomy.

METHODS: Thirty-four children undergoing laparoscopic appendectomy were randomly allocated to receive mechanical ventilation using either VCV (n=17) or PCV (n=17) mode. Positive end-expiratory pressure (PEEP) 5 cm H(2)O was applied to all patients. Hemodynamic and ventilatory parameters were measured 10 minutes before pneumoperitoneum (T1) and 30 minutes after pneumoperitoneum (T2).

RESULTS: Peak and mean airway pressures were significantly increased at T2 from T1 in both groups. Mean airway pressure was significantly higher in the PCV group compared with that in the VCV group. Dynamic compliance was significantly higher in the PCV group than in the VCV group at T2, although it was decreased at T2 from T1 in both groups. Mean blood pressure was significantly increased at T2 from T1 in both groups without intergroup difference. During the study period, SpO(2) remained constant without intergroup or within-group differences.

CONCLUSION: During laparoscopy, mean airway pressure and dynamic compliance were significantly higher during PCV with 5 cm H(2)O PEEP compared with that in VCV with 5 cm H(2)O PEEP. And, as there were no differences in other ventilatory parameters and oxygen saturation, both VCV and PCV can be used safely in children undergoing laparoscopic surgery.