Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1717-1725
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1717
Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopic-assisted radical gastrectomy
Jian Tan, Cheng-Ming Bao, Xiao-Yuan Chen
Jian Tan, Department of Critical Care Medicine, Lishui District People's Hospital, Nanjing 211200, Jiangsu Province, China
Cheng-Ming Bao, Xiao-Yuan Chen, Department of Ultrasound Medicine, Lishui District People's Hospital, Nanjing 211200, Jiangsu Province, China
Co-first authors: Jian Tan and Cheng-Ming Bao.
Author contributions: Tan J and Bao CM contributed equally to this work and are co-first authors; Tan J and Bao CM designed the research and wrote the first manuscript; Tan J, Bao CM and Chen XY contributed to conceiving the research and analyzing data; Tan J and Bao CM conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Lishui District People's Hospital (Approval No. 2024KY0227-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Dr. Chen has nothing to disclose.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yuan Chen, BSc, Doctor, Department of Ultrasound Medicine, Lishui District People's Hospital, No. 86 Chongwen Road, Yongyang Street, Lishui District, Nanjing 211200, Jiangsu Province, China. chenjian-01@sohu.com
Received: March 5, 2024
Revised: May 21, 2024
Accepted: May 24, 2024
Published online: June 27, 2024
Processing time: 116 Days and 22.3 Hours
Abstract
BACKGROUND

Laparoscopic-assisted radical gastrectomy (LARG) is the standard treatment for early-stage gastric carcinoma (GC). However, the negative impact of this procedure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.

AIM

To investigate the influence of pressure-controlled ventilation volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score (LUS).

METHODS

The study included 103 patients with GC undergoing LARG from May 2020 to May 2023, with 52 cases undergoing PCV-VG (research group) and 51 cases undergoing VCV (control group). LUS were recorded at the time of entering the operating room (T0), 20 minutes after anesthesia with endotracheal intubation (T1), 30 minutes after artificial pneumoperitoneum (PP) establishment (T2), and 15 minutes after endotracheal tube removal (T5). For blood gas analysis, arterial partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were observed. Peak airway pressure (Ppeak), plateau pressure (Pplat), mean airway pressure (Pmean), and dynamic pulmonary compliance (Cdyn) were recorded at T1 and T2, 1 hour after PP establishment (T3), and at the end of the operation (T4). Postoperative pulmonary complications (PPCs) were recorded. Pre- and postoperative serum interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay.

RESULTS

Compared with those at T0, the whole, anterior, lateral, posterior, upper, lower, left, and right lung LUS of the research group were significantly reduced at T1, T2, and T5; in the control group, the LUS of the whole and partial lung regions (posterior, lower, and right lung) decreased significantly at T2, while at T5, the LUS of the whole and some regions (lateral, lower, and left lung) increased significantly. In comparison with the control group, the whole and regional LUS of the research group were reduced at T1, T2, and T5, with an increase in PaO2, decrease in PaCO2, reduction in Ppeak at T1 to T4, increase in Pmean and Cdyn, and decrease in Pplat at T4, all significant. The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively. Postoperative IL-1β, IL-6, and TNF-α significantly increased in both groups, with even higher levels in the control group.

CONCLUSION

LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV. Under the lung protective ventilation strategy, the PCV-VG mode more significantly improved intraoperative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production, thereby alleviating lung injury.

Keywords: Lung ultrasound score, Pressure-controlled ventilation volume-guaranteed, Laparoscopic-assisted radical gastrectomy, Blood gas analysis indexes, Pulmonary ventilation

Core Tip: This study mainly analyzed the effects of pressure-controlled ventilation volume-guaranteed (PCV-VG) and volume-controlled ventilation (VCV) on blood gas analysis and pulmonary ventilation in patients with gastric carcinoma (GC) undergoing laparoscopic-assisted radical gastrectomy (LARG) based on the lung ultrasound score (LUS). We performed validation analyses by evaluating the peak airway pressure (Ppeak), plateau pressure (Pplat), mean airway pressure (Pmean), dynamic pulmonary compliance (Cdyn), occurrence of postoperative pulmonary complications (PPCs), and levels of serum interleukin (IL)-1β, IL-6, and tumor necrosis factor-α before and after surgery. We confirmed that LUS can indicate non-uniformity and postural changes in lung ventilation under the two ventilation modes. However, PCV-VG is superior to VCV in significantly alleviating lung injury and inflammatory responses in patients undergoing LARG for GC, improving lung ventilation, and exerting a protective effect against PPCs. Thus, PCV-VG is a practical ventilation option in clinical practice.