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

Abstract

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 H 2 O, P low starting at 4 cm H 2 O, 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 H 2 O until a maximal V T was observed. Inspired oxygen fraction (FIO 2 ) was 1.0 and tidal volume (V T ) 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 < 0.05). Patients in the PIV group showed better pulmonary function test results on postoperative day 1 ( P < 0.05). VAS and nausea and vomiting scores did not differ significantly between the two groups. Conclusion: Pressure-controlled inverse ratio ventilation during open abdominal surgery lasting >2 h was well tolerated and improved respiratory compliance and lung function on the first postoperative day.