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

Translated title of the contribution: The impact of two different inspiratory to expiratory ratios (1:1 and 1:2) on respiratory mechanics and oxygenation during volume-controlled ventilation in robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial

Min Soo Kim, Na Young Kim, Ki Young Lee, Young Deuk Choi, Jung Hwa Hong, Sun Joon Bai

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 languageFrench
Pages (from-to)979-987
Number of pages9
JournalCanadian Journal of Anesthesia
Volume62
Issue number9
DOIs
Publication statusPublished - 2015 Sep 17

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Respiratory Mechanics
Prostatectomy
Cardiac Output
Pneumoperitoneum
Ventilation
Randomized Controlled Trials
Linear Models
Confidence Intervals
Arterial Pressure
Anesthesia
Gases
Hemodynamics
Oxygen
Pressure

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

@article{cb6049f6244d47cb93d7d70e303aadb5,
title = "L’impact de deux ratios inspiratoire {\`a} expiratoire diff{\'e}rents (1:1 et 1:2) sur la m{\'e}canique respiratoire et l’oxyg{\'e}nation pendant la ventilation en volume contr{\^o}l{\'e} en cas de prostatectomie radicale laparoscopique sous assistance robotis{\'e}e: une {\'e}tude randomis{\'e}e contr{\^o}l{\'e}e",
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).",
author = "Kim, {Min Soo} and Kim, {Na Young} and Lee, {Ki Young} and Choi, {Young Deuk} and Hong, {Jung Hwa} and Bai, {Sun Joon}",
year = "2015",
month = "9",
day = "17",
doi = "10.1007/s12630-015-0383-2",
language = "French",
volume = "62",
pages = "979--987",
journal = "Canadian Journal of Anaesthesia",
issn = "0832-610X",
publisher = "Springer New York",
number = "9",

}

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).

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