ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectiveTo evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. ResultsThe PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. ConclusionAmong adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.
ObjectiveTo compare the effects of flow-controlled ventilation (FCV) and conventional pressure-controlled ventilation (PCV) on postoperative pulmonary complications (PPCs) within 7 days after elective thoracic surgery. Methods Patients scheduled for elective thoracic surgery at Langzhong People's Hospital between August 2024 and June 2025 were enrolled and randomly assigned in a 1:1 ratio to either the FCV group or PCV group. The primary outcome was the incidence of PPCs within 7 days postoperatively. Secondary outcomes included systemic inflammatory factor levels at 24 hours postoperatively, numerical rating scale (NRS) pain scores at 3 days postoperatively, post-anesthesia care unit (PACU) stay duration, and length of postoperative hospitalization. Mechanical power (MP), oxygenation index, partial pressure of arterial carbon dioxide (PaCO2), peak pressure (Ppeak), positive end-expiratory pressure (PEEP), tidal volume (VT), respiratory rate (RR), and minute ventilation (MV) were compared between groups at 30 and 60 minutes after one-lung ventilation (OLV). Differences in MP between patients with and without PPCs were analyzed, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of MP for PPCs using area under the curve (AUC). Results A total of 60 patients were included: 30 in the FCV group [17 males, 13 females, mean age (57.4±10.0) years] and 30 in the PCV group [18 males, 12 females; mean age (58.7±11.2) years]. The FCV group demonstrated a significantly lower incidence of PPCs compared to the PCV group (16.7% vs. 40.0%, P=0.045) and reduced systemic pro-inflammatory factor levels at 24 hours postoperatively. No statistically significant difference was observed in NRS pain scores between groups at 3 days postoperatively. Additionally, the FCV group showed shorter PACU stay duration [(51.8±11.5) min vs. (66.2±24.5) min, P=0.008] and reduced postoperative hospitalization time [(7.8±1.2) d vs. (8.9±2.5) d, P=0.034]. At both 30 and 60 minutes after OLV initiation, the FCV group exhibited lower MP, MV, and RR values alongside higher oxygenation indices and VT compared to the PCV group, while PaCO2 and PEEP showed no significant differences. Although Ppeak did not differ significantly between groups at 30 minutes after OLV, it was lower in the PCV group at 60 minutes. Patients who developed PPCs consistently demonstrated higher MP values than those without PPCs at both time points. ROC curve analysis revealed excellent predictive performance of MP for PPCs occurrence within 7 days postoperatively (30-minute OLV: AUC=0.97, P<0.001; 60-minute OLV: AUC=0.93, P<0.001). Conclusion Compared with PCV, implementing FCV during OLV significantly reduces PPCs incidence. This protective effect may be attributed to reduced MP, improved oxygenation, enhanced ventilatory efficiency, and attenuated inflammatory responses. As a lung-protective ventilatory strategy, FCV effectively promotes postoperative recovery in patients undergoing elective thoracic surgery with American Society of Anesthesiologists physical status classification Ⅰ-Ⅲ.
