Lateral Dekübit Pozisyonda Hacim Kontrollü Ventilasyon Modu ve Hacim Garantili Basınç Kontrollü Ventilasyon Modlarının Değerlendirilmesi; Randomize Kontrollü Çalışma

Year 2024, Volume: 3 Issue: 2, 26 - 31, 25.08.2024

Ela Nur Medetoğlu Köksal , Veysel Köksal , Kenan Gülbahar , Erkan Cem Çelik

https://doi.org/10.61745/jsmsau.1517872

Abstract

Amaç: Bu çalışmanın amacı, Genel anestezi altında lateral dekübit pozisyonda iki ventilasyon modunun (hacim kontrollü ventilasyon (VCV) ve hacim garantili basınç kontrollü ventilasyon (PCV-VG)) laparoskopik sırasında hasta hemodinamikleri, akciğer mekaniği ve alveoler gaz değişimi üzerindeki etkisini incelemeyi amaçlamaktadır.
Yöntemler: Çalışmaya laparoskopik nefrektomi planlanan, ASA I-II olarak sınıflandırılan, 18-65 yaş arası 60 hasta dâhil edildi. Hastalar rastgele VCV veya PCV-VG grubuna ayrıldı. Hastaların demografik özellikleri, ameliyat ayrıntıları, ameliyat süresi ve ameliyatın tarafı ve tepe basıncı (Ppeak), ortalama basınç (Pmean), PaO2, PaCO2, SaO2 ve hematokrit (htc) gibi yanal dekübitten önce sırtüstü pozisyonda (T1), yanal dekübitten 5 dakika sonra (T1) T2), ameliyat sonunda lateral dekübitte (T3) ve ekstübasyon öncesi sırtüstü pozisyonda (T4) olmak üzere parametreler dört zaman noktasında kaydedildi.
Bulgular: T1, T2, T3 ve T4'teki ventilasyon parametreleri ve kan gazı değerleri değerlendirildiğinde, gruplar arasında T2’de Ppeak ve T3'te ki Pmean'de anlamlı farklılıklar görüldü (P<.05). Gruplar arasında PaO2, SaO2 ve PaCO2 değerlerinde anlamlı fark görülmedi (P>,05). Gruplar içerisinde farklı zaman dilimlerinde Ppeak, Pmean, htc, sistolik kan basıncı (SBP), diastolik kan basıncı (DBP) ve nabız parametrelerinde anlamlı fark mevcuttu (P<.05). Diğer parametrelerde anlamlı farklılık yoktu (P<,05).
Sonuç: Farklı ventilasyon modlarının farklı klinik durumlar için benzersiz faydaları vardır. PCV-VG modu basınç parametrelerinde anlamlı düşüş sağlarken kan gazı parametrelerinde farklılık gözlenmedi.

Keywords

Genel anestezi, Laparoskopik nefrektomi, Lateral dekübit pozisyon, Ventilasyon

Evaluation of Volume Controlled Ventilation Mode and Volume Guaranteed Pressure Controlled Ventilation Modes in Lateral Decubitus Position; Randomized Controlled Study

Abstract

Objectives: This study aims to examine the impact of two ventilation modes—volume-controlled ventilation (VCV) and volume-guaranteed pressure-controlled ventilation (PCV-VG)—on patient hemodynamic, lung mechanics, and alveolar gas exchange during laparoscopic surgery in the lateral decubitus position under general anaesthesia.
Methods: The study included 60 patients, aged 18-65, classified as ASA I-II, who were scheduled for laparoscopic nephrectomy. Patients were randomly assigned to either the VCV or PCV-VG group. Parameters such as peak pressure (Ppeak), mean pressure (Pmean), PaO2, PaCO2, SaO2, and haematocrit (htc) were recorded at four time points: in the supine position before lateral decubitus (T1), 5 minutes after lateral decubitus (T2), at the end of surgery in lateral decubitus (T3), and in the supine position before extubation (T4). Additional data collected included patient demographics, surgery details, operation time, and the side of the operation.
Results: When ventilation parameters and blood gas values at T1, T2, T3 and T4 were evaluated, significant differences were seen between the groups in Ppeak at T2 and Pmean at T3 (P<.05). There was no significant difference in PaO2, SaO2 and PaCO2 values between the groups (P>.05). There was a significant difference in Ppeak, Pmean, htc, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse parameters between the groups at different time periods (P<.05). There was no significant difference in other parameters (P<.05).
Conclusions: Different ventilation modes have unique benefits for different clinical situations. While PCV-VG mode provided a significant decrease in pressure parameters, no difference was observed in blood gas parameters.

Keywords

General Anesthesia, Laparoscopic Nephrectomy, Lateral Decubitus Position, Ventilation

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