Effects of volume-controlled ventilation vs. pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma

Abstract

Background

The best ventilation approach for patients undergoing video-assisted thoracic surgery (ATS) for pulmonary carcinoma remains undefined. This study aimed to assess hemodynamics, airway pressure, arterial blood gas, and inflammatory factors in patients undergoing VATS for pulmonary carcinoma under volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV).

Methods

This was a prospective study of 60 patients with pulmonary carcinoma treated at a tertiary center in 2015–2016. The subjects were randomized to the VCV or PCV group after anesthesia and total lung ventilation (TLV). Hemodynamics and blood gas parameters were compared between the two groups pre-OLV (one-lung ventilation) (T1) and after 30 (T2), 60 (T3), and 120 (T4) minutes of OLV. Radial artery blood was collected to measure interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α levels.

Results

Hemodynamic and blood gas parameters were similar between the two groups (all P>0.05). During OLV, airway resistance (RAW) was significantly lower in the PCV group compared with the VCV group at T2 (26.0±3.8 vs. 29.9±7.3 cmH ₂O/L/s), T3 (26.0±3.7 vs. 30.2±7.7 cmH ₂O/L/s), and T4 (25.8±4.1 vs. 29.6±6.7 cmH ₂O/L/s). Similar trends were found for peak pressure (Ppeak) and plateau pressure (Pplat). Mean pressure (Pmean) was similar between the two groups. Compared with the PCV group, TNF-α and IL-6 levels in the VCV group were significantly increased (all P<0.05). The levels of the anti-inflammatory mediator IL-10 were higher in the PCV group compared with the VCV group.

Conclusions

PCV for OLV during radical resection of pulmonary carcinoma by VATS could reduce Ppeak and downregulate pro-inflammatory factors, likely decreasing airway injury.