Comparative Study Between the Effect of Volume-Controlled Ventilation and Pressure-Controlled Ventilation Volume Guaranteed in Obese Patients in Laparoscopic Assisted Surgery

Abstract

Background & objective: Obesity has been termed as an epidemic in the developed countries, although it can also be seen in poor countries. With more and more obese surgical patients, anesthetic protocols have to be evolved. Ventilation of obese patients during surgery is seen to be a prime concern. The objective of this study was to evaluate the efficacy of Pressure Controlled Ventilation-Volume Guaranteed (PCV-VG) in comparison to volume-controlled ventilation (VCV) modes in obese patients undergoing laparoscopic assisted surgery in the Trendelenburg position, with a focus on their lung compliance and oxygenation index (OI).

Methodology: This randomized controlled clinical trial involved 64 obese patients of both sexes, all with a Body Mass Index (BMI) of ≥ 30 kg/m², and classified as ASA class I or II. The participants were randomly assigned to two equal groups: the study group (Group P) using PCV-VG and the control group (Group V) using VCV.

Results: The arterial oxygen partial pressure (PaO₂) and lung compliance were significantly higher in Group P compared to Group V (P < 0.05). Conversely, the peak pressure (P peak) and plateau pressure (P_plat) along with the mean pressure (P mean) as well as the oxygenation index were significantly lower in Group P compared to Group V (P < 0.05).

Conclusions: PCV-VG significantly improves lung compliance and oxygenation while maintaining lower peak and plateau pressures, with comparable hemodynamic stability and PaCO₂ levels.

Abbreviations: ASA: American Society of Anesthesiologists, BMI: Body Mass Index, EtCO₂: end-tidal carbon dioxide, OI: oxygenation index, PCV-VG: Pressure Controlled Ventilation-Volume Guaranteed, PIP: Peak Inspiratory Pressure, PaO₂: arterial oxygen partial pressure, P peak: peak pressure, P_plat: plateau pressure, PRVC: pressure-regulated volume-controlled, VCV: volume-controlled ventilation,

Keywords: Airway Pressure; Obesity; Oxygenation index; Pressure-Controlled Ventilation-Volume-Guaranteed; Trendelenburg position; Ventilation; Volume-Controlled Ventilation

Citation: Soliman AM, El Seidy MI, Taha SS, El Agamy AES, Youssef AM. Comparative study between the effects of volume-controlled ventilation and pressure-controlled - volume guaranteed ventilation in patients with obesity during laparoscopic surgery. Anaesth. pain intensive care 2025;29(3):548-555.                                      

DOI: 10.35975/apic.v29i3.2629

Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025