Abstract
Background: Volume-controlled ventilation with a prolonged inspiratory to expiratory ratio (I:E ratio) has been used to optimize gas exchange and respiratory mechanics in various surgical settings. We hypothesized that, when compared with an I:E ratio of 1:2, a prolonged I:E ratio of 1:1 would improve respiratory mechanics without reducing cardiac output (CO) during pneumoperitoneum and steep Trendelenburg positioning, both of which can impair respiratory function in robot-assisted laparoscopic radical prostatectomy. Furthermore, we evaluated its effect on oxygenation during robot-assisted laparoscopic radical prostatectomy. Methods: Eighty patients undergoing robot-assisted laparoscopic radical prostatectomy were randomly allocated to receive an I:E ratio of either 1:1 (group 1:1) or 1:2 (group 1:2). The primary endpoint, peak airway pressure (Ppeak), as well as hemodynamic data, including cardiac output (CO) and arterial oxygen tension (PaO 2 ), were compared between groups at four time points: ten minutes after anesthesia induction (T1), 30 and 60 min after pneumoperitoneum with steep Trendelenburg positioning (T2 and T3), and ten minutes after supine positioning (T4). Overall comparisons were made between groups using linear mixed model analysis with post hoc testing of individual time points adjusted using a Bonferroni correction. Results: Linear mixed model analysis showed a significant overall difference in Ppeak between the two groups (P < 0.001). Post hoc analysis showed a significantly lower mean (SD) Ppeak in group 1:1 than in group 1:2 at T2 [28.4 (4.0) cm H 2 O vs 32.8 (5.2) cm H 2 O, respectively; mean difference, 4.3 cm H 2 O; 95% confidence interval (CI), 2.3 to 6.4; P < 0.001] and T3 [27.8 (3.9) cm H 2 O vs 32.6 (5.0) cm H 2 O, respectively; mean difference, 4.7 cm H 2 O; 95% CI, 2.7 to 6.7; P < 0.001]. The CO assessed over these time points was comparable in both groups (P = 0.784). In addition, there were no significant differences in PaO 2 between the two groups (P = 0.521). Conclusions: Compared with an I:E ratio of 1:2, a ratio of 1:1 lowered Ppeak without reducing CO during pneumoperitoneum and steep Trendelenburg positioning. Nevertheless, our results did not support its use solely for improving oxygenation. This trial was registered at http://clinicaltrials.gov/ (NCT01892449).
| Original language | French |
|---|---|
| Pages (from-to) | 979-987 |
| Number of pages | 9 |
| Journal | Canadian Journal of Anesthesia |
| Volume | 62 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 2015 Sep 17 |
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All Science Journal Classification (ASJC) codes
- Anesthesiology and Pain Medicine
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L’impact de deux ratios inspiratoire à expiratoire différents (1:1 et 1:2) sur la mécanique respiratoire et l’oxygénation pendant la ventilation en volume contrôlé en cas de prostatectomie radicale laparoscopique sous assistance robotisée : une étude randomisée contrôlée. / Kim, Min Soo; Kim, Na Young; Lee, Ki Young; Choi, Young Deuk; Hong, Jung Hwa; Bai, Sun Joon.
In: Canadian Journal of Anesthesia, Vol. 62, No. 9, 17.09.2015, p. 979-987.Research output: Contribution to journal › Article
TY - JOUR
T1 - L’impact de deux ratios inspiratoire à expiratoire différents (1:1 et 1:2) sur la mécanique respiratoire et l’oxygénation pendant la ventilation en volume contrôlé en cas de prostatectomie radicale laparoscopique sous assistance robotisée
T2 - une étude randomisée contrôlée
AU - Kim, Min Soo
AU - Kim, Na Young
AU - Lee, Ki Young
AU - Choi, Young Deuk
AU - Hong, Jung Hwa
AU - Bai, Sun Joon
PY - 2015/9/17
Y1 - 2015/9/17
N2 - Background: Volume-controlled ventilation with a prolonged inspiratory to expiratory ratio (I:E ratio) has been used to optimize gas exchange and respiratory mechanics in various surgical settings. We hypothesized that, when compared with an I:E ratio of 1:2, a prolonged I:E ratio of 1:1 would improve respiratory mechanics without reducing cardiac output (CO) during pneumoperitoneum and steep Trendelenburg positioning, both of which can impair respiratory function in robot-assisted laparoscopic radical prostatectomy. Furthermore, we evaluated its effect on oxygenation during robot-assisted laparoscopic radical prostatectomy. Methods: Eighty patients undergoing robot-assisted laparoscopic radical prostatectomy were randomly allocated to receive an I:E ratio of either 1:1 (group 1:1) or 1:2 (group 1:2). The primary endpoint, peak airway pressure (Ppeak), as well as hemodynamic data, including cardiac output (CO) and arterial oxygen tension (PaO 2 ), were compared between groups at four time points: ten minutes after anesthesia induction (T1), 30 and 60 min after pneumoperitoneum with steep Trendelenburg positioning (T2 and T3), and ten minutes after supine positioning (T4). Overall comparisons were made between groups using linear mixed model analysis with post hoc testing of individual time points adjusted using a Bonferroni correction. Results: Linear mixed model analysis showed a significant overall difference in Ppeak between the two groups (P < 0.001). Post hoc analysis showed a significantly lower mean (SD) Ppeak in group 1:1 than in group 1:2 at T2 [28.4 (4.0) cm H 2 O vs 32.8 (5.2) cm H 2 O, respectively; mean difference, 4.3 cm H 2 O; 95% confidence interval (CI), 2.3 to 6.4; P < 0.001] and T3 [27.8 (3.9) cm H 2 O vs 32.6 (5.0) cm H 2 O, respectively; mean difference, 4.7 cm H 2 O; 95% CI, 2.7 to 6.7; P < 0.001]. The CO assessed over these time points was comparable in both groups (P = 0.784). In addition, there were no significant differences in PaO 2 between the two groups (P = 0.521). Conclusions: Compared with an I:E ratio of 1:2, a ratio of 1:1 lowered Ppeak without reducing CO during pneumoperitoneum and steep Trendelenburg positioning. Nevertheless, our results did not support its use solely for improving oxygenation. This trial was registered at http://clinicaltrials.gov/ (NCT01892449).
AB - Background: Volume-controlled ventilation with a prolonged inspiratory to expiratory ratio (I:E ratio) has been used to optimize gas exchange and respiratory mechanics in various surgical settings. We hypothesized that, when compared with an I:E ratio of 1:2, a prolonged I:E ratio of 1:1 would improve respiratory mechanics without reducing cardiac output (CO) during pneumoperitoneum and steep Trendelenburg positioning, both of which can impair respiratory function in robot-assisted laparoscopic radical prostatectomy. Furthermore, we evaluated its effect on oxygenation during robot-assisted laparoscopic radical prostatectomy. Methods: Eighty patients undergoing robot-assisted laparoscopic radical prostatectomy were randomly allocated to receive an I:E ratio of either 1:1 (group 1:1) or 1:2 (group 1:2). The primary endpoint, peak airway pressure (Ppeak), as well as hemodynamic data, including cardiac output (CO) and arterial oxygen tension (PaO 2 ), were compared between groups at four time points: ten minutes after anesthesia induction (T1), 30 and 60 min after pneumoperitoneum with steep Trendelenburg positioning (T2 and T3), and ten minutes after supine positioning (T4). Overall comparisons were made between groups using linear mixed model analysis with post hoc testing of individual time points adjusted using a Bonferroni correction. Results: Linear mixed model analysis showed a significant overall difference in Ppeak between the two groups (P < 0.001). Post hoc analysis showed a significantly lower mean (SD) Ppeak in group 1:1 than in group 1:2 at T2 [28.4 (4.0) cm H 2 O vs 32.8 (5.2) cm H 2 O, respectively; mean difference, 4.3 cm H 2 O; 95% confidence interval (CI), 2.3 to 6.4; P < 0.001] and T3 [27.8 (3.9) cm H 2 O vs 32.6 (5.0) cm H 2 O, respectively; mean difference, 4.7 cm H 2 O; 95% CI, 2.7 to 6.7; P < 0.001]. The CO assessed over these time points was comparable in both groups (P = 0.784). In addition, there were no significant differences in PaO 2 between the two groups (P = 0.521). Conclusions: Compared with an I:E ratio of 1:2, a ratio of 1:1 lowered Ppeak without reducing CO during pneumoperitoneum and steep Trendelenburg positioning. Nevertheless, our results did not support its use solely for improving oxygenation. This trial was registered at http://clinicaltrials.gov/ (NCT01892449).
UR - http://www.scopus.com/inward/record.url?scp=84939138756&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84939138756&partnerID=8YFLogxK
U2 - 10.1007/s12630-015-0383-2
DO - 10.1007/s12630-015-0383-2
M3 - Article
C2 - 25869025
AN - SCOPUS:84939138756
VL - 62
SP - 979
EP - 987
JO - Canadian Journal of Anaesthesia
JF - Canadian Journal of Anaesthesia
SN - 0832-610X
IS - 9
ER -