Fluss-gesteuerte Beatmung und perioperative Lungenfunktion bei Roboter-assistierten Eingriffen in tiefer Trendelenburglagerung
The DaVinci® prostatectomy is well-regarded for its precision, minimally invasive approach, and rapid patient recovery. However, the combination of extreme patient positioning and the insufflation of carbon dioxide into the abdominal cavity during this surgical method can lead to lingering impairments in lung function. Until now, modifications to traditional ventilation techniques have not been able to mitigate these postoperative pulmonary restrictions effectively. Since 2017, flow-controlled ventilation (FCV®) has emerged with distinct characteristics setting it apart from standard volume- or pressure-controlled ventilation. Despite this, there are no studies that specifically explore how flow-controlled ventilation affects patient outcomes in DaVinci® prostatectomies.
This study aimed to evaluate the impact of flow-controlled ventilation on perioperative lung function through spirometric measurements. The primary focus was on assessing the ratio of maximal expiratory flow to maximal inspiratory flow at 50% of vital capacity (MEF50/MIF50) alongside other parameters, including vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1). These were compared to outcomes with conventional pressure-controlled ventilation (PCV).
Twenty patients were included in this study, with lung function measurements conducted preoperatively, immediately postoperatively, and at intervals of 30, 120, and 240 minutes after surgery, as well as on postoperative days 1 and 5. This allowed for both short- and mid-term assessments of lung function changes. Intraoperative ventilation parameters were also documented and compared to a historical control group.
The findings indicated a significant increase in the MEF50/MIF50 ratio immediately following surgery, suggesting greater expiratory flow limitation, though this normalized within 24 hours postoperatively. Changes in VC and FEV1 were observed up to the fifth postoperative day. The alterations in lung function with FCV were similar to those seen in patients managed with PCV, indicating that FCV may serve as a comparable option for maintaining lung function during DaVinci® prostatectomy. Intraoperatively, FCV showed ventilation parameters that could be interpreted as lung-protective when compared to the pressure-controlled ventilated control group. Overall, the results suggest that flow-controlled ventilation (FCV®) is a suitable method for ventilating patients undergoing robot-assisted prostatectomy in the deep Trendelenburg position.
This study aimed to evaluate the impact of flow-controlled ventilation on perioperative lung function through spirometric measurements. The primary focus was on assessing the ratio of maximal expiratory flow to maximal inspiratory flow at 50% of vital capacity (MEF50/MIF50) alongside other parameters, including vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1). These were compared to outcomes with conventional pressure-controlled ventilation (PCV).
Twenty patients were included in this study, with lung function measurements conducted preoperatively, immediately postoperatively, and at intervals of 30, 120, and 240 minutes after surgery, as well as on postoperative days 1 and 5. This allowed for both short- and mid-term assessments of lung function changes. Intraoperative ventilation parameters were also documented and compared to a historical control group.
The findings indicated a significant increase in the MEF50/MIF50 ratio immediately following surgery, suggesting greater expiratory flow limitation, though this normalized within 24 hours postoperatively. Changes in VC and FEV1 were observed up to the fifth postoperative day. The alterations in lung function with FCV were similar to those seen in patients managed with PCV, indicating that FCV may serve as a comparable option for maintaining lung function during DaVinci® prostatectomy. Intraoperatively, FCV showed ventilation parameters that could be interpreted as lung-protective when compared to the pressure-controlled ventilated control group. Overall, the results suggest that flow-controlled ventilation (FCV®) is a suitable method for ventilating patients undergoing robot-assisted prostatectomy in the deep Trendelenburg position.