Pressure-Controlled Inverse Ratio Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

Background: Studies have shown that pressure-controlled ventilation improves alveolar gas distribution. And inverse ratio ventilation has advantages of improving oxygenation in acute respiratory distress syndrome (ARDS) patients. However, the effects that pressure-controlled inverse ration ventilation in patients undergoes endotracheal intubation general anesthesia have not been assessed. Objective: To investigate whether pressure-controlled inverse ratio ventilation (PIV) would improve ventilatory and oxygenation parameters as well as lung function compared to conventional ventilation in patients undergoing open abdominal surgery. Interventions: In the conventional ventilation (CV) group, the ventilation strategy involved zero end-expiratory pressure and volume-controlled ventilation. In the pressure-controlled inverse ratio ventilation (PIV) group, the strategy involved P high starting at 7 cm H2O, P low starting at 4 cm H2O, T high at 4 s, T low at 2 s, and an inspiratory-to-expiratory time ratio of 2:1. The ΔP value was adjusted according to VT. Pressure levels were increased by 2 cm H2O until a maximal VT was observed. Inspired oxygen fraction (FIO2) was 1.0 and tidal volume (VT) was 6 mL/kg in both groups. Main Outcome Measures: The primary outcome is pulmonary function tests. Hemodynamic, ventilatory and oxygenation parameters were measured;visual analog scale (VAS) scores, and nausea and vomiting scores were also measured. Results: The PIV group tolerated pressure-controlled inverse ratio ventilation without significant hemodynamic instability. Mean airway pressure and static compliance were significantly higher in the PIV group than those in CV group (P P 2 h was well tolerated and improved respiratory compliance and lung function on the first postoperative day.

Neural control of pressure support ventilation improved patient-ventilator synchrony in patients with different respiratory system mechanical properties:a prospective,crossover trial

Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing to an increased inspiratory effort.Using diaphragm electrical activity,neurally controlled pressure support(PSN)could hypothetically eliminate the asynchrony and reduce inspiratory effort.The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony,inspiratory effort,and breathing pattern.Methods:Eight post-operative patients without respiratory system comorbidity,eight patients with acute respiratory distress syndrome(ARDS)and obvious restrictive acute respiratory failure(ARF),and eight patients with chronic obstructive pulmonary disease(COPD)and mixed restrictive and obstructive ARF were enrolled.Patient-ventilator interactions were analyzed with macro asynchronies(ineffective,double,and auto triggering),micro asynchronies(inspiratory trigger delay,premature,and late cycling),and the total asynchrony index(AI).Inspiratory efforts for triggering and total inspiration were analyzed.Results:Total AI of PSN was consistently lower than that of PSP in COPD(3%vs.93%,P=0.012 for 100%support level;8%vs.104%,P=0.012 for 150%support level),ARDS(8%vs.29%,P=0.012 for 100%support level;16%vs.41%,P=0.017 for 150%support level),and post-operative patients(21%vs.35%,P=0.012 for 100%support level;15%vs.50%,P=0.017 for 150%support level).Improved support levels from 100%to 150%statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS.Patients’inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels(P<0.05).There was no difference in breathing patterns between PSN and PSP.Conclusions:PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties.PSN,which reduces the trigger and total patient’s inspiratory effort in patients with COPD or ARDS,might be an alternative mode for PSP.Trial Registration:ClinicalTrials.gov,NCT01979627;https://clinicaltrials.gov/ct2/show/record/NCT01979627.