The effect of pressure controlled ventilation-volume guaranteed combined with personalized positive end expiratory pressure ventilation on oxygenation function and postoperative pulmonary complications in patients undergoing brain tumor surgery
Objective To explore the ventilation strategy of using pressure controlled ventilation-volume guaranteed(PCV-VG)mode combined with personalized positive end expiratory pressure(PEEP)during surgery,and its impact on oxygenation function and incidence of postoperative pulmonary complications(PPCs)in patients undergoing brain tumor surgery.Methods Sixty patients who underwent elective brain tumor surgery at the Linyi People's Hospital from January 2023 to June 2023 were selected.The patients were randomly divided into PCV-VG ventilation mode group(T group)and volume controlled ventilation(VCV)mode group(C group)using a random number table method,with 30 patients in each group.One patient was excluded from group T due to changes in the condition,and 29 patients were actually included.Group T adopted PCV-VG ventilation mode and searched for the maximum dynamic lung compliance(Cdyn)by titrating PEEP.The PEEP corresponding to the maximum Cdyn value was the optimal PEEP,which was maintained until the end of mechanical ventilation.Group C adopted a ventilation mode of VCV plus 5 cmH2O fixed value PEEP.All patients underwent arterial blood gas analysis before anesthesia induction(T1),15 minutes after setting ventilation mode(T2),and 15 minutes after extubation(T3),recording arterial oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2),lactate(Lac),and blood glucose(Glu),and calculating oxygenation index(PaO2/FiO2).The levels of white blood cells(WBC),C-reactive protein(CRP),and procalcitonin(PCT)were recorded before and 72 hours after surgery.The incidence of postoperative PPCs at 72 hours was observed.Results There was a statistically significant difference in the grouping effect and time effect of PaO2 and PaCO2 between group C and group T(all P＜0.05),while there was no statistically significant difference in the interaction effect(all P＞0.05);The differences in grouping effects,time effects,and interaction effects of PaO2/FiO2 between group C and group T were statistically significant(all P＜0.05);The average value of the optimized PEEP obtained by T-group titration was 7.48 cmH2O,corresponding to an average platform pressure(Pplat)of 14.90 cmH2O,and an average value of 53.37 ml/cmH2O corresponding to the maximum Cdyn value.Compared with the Pplat and Cdyn corresponding to the fixed value of 5 cmH2O PEEP in Group C,the Pplat corresponding to the optimized PEEP in Group T was lower than that in Group C(P＜0.05),and the Cdyn was higher than that in group C(P＜0.05).The CRP level and incidence of PPCs in group T after 72 hours of surgery were significantly lower than those in group C(all P＜0.05).Conclusions Compared with VCV,the ventilation mode of PCV-VG combined with personalized PEEP can improve intraoperative lung ventilation and oxygenation function in patients with brain tumors,reduce the occurrence of pulmonary inflammation 72 hours after surgery,and lower the incidence of PPCs.
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