Comparison of VCV and PCV-VG modes on diaphragmatic function in diabetic patients undergoing laparoscopic colorectal surgery: a prospective randomized controlled study.
Yanan Wang, Linyao Chen, Zixuan Xu et al.
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In 30 seconds
This prospective randomized controlled study compared pressure-controlled volume-guaranteed ventilation (PCV-VG) with volume-controlled ventilation (VCV) in 80 adults with type II diabetes undergoing elective laparoscopic colorectal surgery. Under a driving pressure-guided strategy, PCV-VG was associated with lower intraoperative mechanical power and better preservation of several measures of diaphragmatic function during the first two postoperative days. Postoperative diaphragmatic weakness was less frequent with PCV-VG (p = 0.019), but postoperative pulmonary complication rates did not differ significantly between groups (p = 0.155).
Key findings
- Average mechanical power was significantly lower with PCV-VG than VCV (p = 0.002).
- PCV-VG improved tidal-breathing diaphragm thickening fraction (p = 0.004) and maximal-effort diaphragm excursion (p = 0.029) and thickening fraction (p = 0.017); tidal-breathing excursion did not differ significantly (p = 0.088).
- Postoperative diaphragmatic weakness was less frequent with PCV-VG (p = 0.019), while postoperative pulmonary complication incidence did not differ (p = 0.155).
Why it matters
Diaphragmatic dysfunction after surgery may be relevant to respiratory recovery, and this trial suggests ventilation mode can affect early postoperative diaphragm measures in patients with type II diabetes. However, the absence of a difference in pulmonary complications means the observed physiological improvements did not demonstrate a corresponding clinical benefit in this study.
What to keep in mind
The study included 80 patients undergoing one type of elective surgery, and follow-up of diaphragmatic function was limited to the first two postoperative days.