Our Summary

This research was conducted to see if two types of ventilator modes (pressure-controlled ventilation or PCV, and pressure-controlled ventilation-volume guaranteed or PCV-VG) are better than volume-controlled ventilation (VCV) in improving breathing during surgery in infants and young children placed in a face-down (prone) position. The test was conducted during a specific type of surgery (spinal cord detethering) on children aged 1 month to 3 years.

Among the 120 children included in the study, those who were on the VCV mode had higher peak airway pressure (Ppeak) 10 and 30 minutes after being placed in the prone position compared to those on PCV and PCV-VG modes. The prone position normally decreases something called dynamic compliance, a measure of lung elasticity, but this decrease was prevented by the PCV and PCV-VG modes.

Overall, there were no significant differences in other factors such as gas exchange, lung injury biomarkers concentration, heart-rate parameters, and post-surgery breathing complications among the three groups.

The conclusion is that PCV-VG might be a better ventilation mode for infants and young children undergoing this type of surgery in a prone position, because it can control the increase in Ppeak and decrease in Cdyn (dynamic compliance) while maintaining a consistent tidal volume (the amount of air the patient breathes in and out).

FAQs

  1. What was the purpose of the research conducted on ventilator modes during surgery?
  2. What were the findings of the study regarding PCV, PCV-VG, and VCV modes?
  3. Why might PCV-VG be a better ventilation mode for infants and young children undergoing spinal cord detethering surgery in a prone position?

Doctor’s Tip

A doctor might tell a patient undergoing detethering surgery that using pressure-controlled ventilation-volume guaranteed (PCV-VG) mode during surgery can help maintain a consistent tidal volume and prevent increases in peak airway pressure and decreases in lung elasticity, compared to volume-controlled ventilation (VCV) mode. This can lead to better breathing outcomes during surgery and may be beneficial for infants and young children in a prone position.

Suitable For

Patients who are recommended for detethering surgery typically have a tethered spinal cord, which occurs when the spinal cord is attached to surrounding tissue, causing abnormal stretching and potential damage. This condition can lead to symptoms such as back pain, leg weakness, bladder or bowel dysfunction, and scoliosis.

Detethering surgery is often recommended for patients who experience progressive neurological symptoms or worsening of existing symptoms related to a tethered spinal cord. It is important to consult with a neurosurgeon or spinal cord specialist to determine if detethering surgery is the appropriate treatment option for a specific patient.

Timeline

Before detethering surgery:

  • Patient is diagnosed with tethered spinal cord syndrome, a condition where the spinal cord is attached to surrounding tissue, causing pain, weakness, and other symptoms.
  • Patient undergoes pre-operative assessment and preparation for surgery, including imaging tests to determine the extent of the tethering.
  • Anesthesia is administered to the patient before surgery begins.
  • Patient is placed in a face-down (prone) position for the surgery.

After detethering surgery:

  • Patient is taken to the recovery room after surgery for monitoring and observation.
  • Patient may experience pain and discomfort at the surgical site, which is managed with pain medications.
  • Patient may need to stay in the hospital for a few days for recovery and monitoring.
  • Patient undergoes physical therapy and rehabilitation to regain strength and function.
  • Follow-up appointments are scheduled to monitor the patient’s progress and address any complications or concerns.

What to Ask Your Doctor

  1. What are the potential risks and benefits of detethering surgery for my child?
  2. How will the surgery impact my child’s quality of life and long-term outcomes?
  3. What are the different ventilation modes available for my child during surgery, and why is PCV-VG recommended in this study?
  4. How will the ventilation mode used during surgery affect my child’s breathing and recovery?
  5. What are the specific factors that were measured in this study (such as Ppeak, dynamic compliance, gas exchange, lung injury biomarkers, heart-rate parameters) and how do they impact my child’s outcome?
  6. How will the choice of ventilation mode during surgery impact the likelihood of post-surgery breathing complications for my child?
  7. Are there any additional considerations or precautions we should take before, during, or after the surgery to ensure the best possible outcome for my child?
  8. Are there any alternative treatment options or approaches we should consider for my child’s condition?

Reference

Authors: Bao C, Cao H, Shen Z, Hu Y, Huang J, Shu Q, Chen Q. Journal: J Clin Anesth. 2024 Aug;95:111440. doi: 10.1016/j.jclinane.2024.111440. Epub 2024 Mar 8. PMID: 38460413