Pressure-Controlled Volume-Guaranteed Ventilation Improves Respiratory Dynamics in Pediatric Patients During Laparoscopic Surgery: A Prospective Randomized Controlled Trial

PURPOSE: Pressure-controlled volume-guaranteed (PCV-VG) combines the characteristics of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV). It has been reported that PCV-VG decreases airway pressure and improves oxygenation among the adult group. In this study, the respiratory dynamics of PCV-VG and VCV are compared in pediatric patients ventilated with laryngeal mask airway and underwent laparoscopic hernia of the sac ligation. PATIENTS AND METHODS: Sixty-four pediatric patients were included in this prospective, randomized clinical trial. Pediatric patients were randomly allocated to receive VCV and PCV-VG ventilation during the general anesthesia. The hemodynamic and respiratory variables were recorded at the time when laryngeal mask airway was placed, pneumoperitoneum began, 5 mins after pneumoperitoneum began, pneumoperitoneum ended, and the operation ended respectively. The respiratory adverse events were recorded after the operation and on the first day after the operation. In this study, respiratory adverse events are defined as cough, hoarseness, hypoxemia, laryngospasm, bronchospasm, and sore throat. RESULTS: There was no statistical difference in hemodynamic variables at all time points between the two groups. Compared to the VCV group, peak airway pressure (Ppeak) and plateau airway pressure in the PCV-VG group decreased significantly. Pulmonary dynamic compliance (Cydn) in the PCV-VG group was significantly higher than that in the VCV group. The respiratory adverse events appeared to have no statistical difference between VCV and PCV groups. CONCLUSION: PCV-VG provides a lower Ppeak and better Cydn in pediatric patients compared with the VCV group during laparoscopic surgery. The results suggested that PCV-VG may be a superior way of mechanical ventilation for pediatric patients who ventilated with laryngeal mask airway and experienced laparoscopic surgery.