Effects of volume-controlled equal ratio ventilation with recruitment maneuver and positive end-expiratory pressure in laparoscopic sleeve gastrectomy: a prospective, randomized, controlled trial

Abstract

Background/aim: We compared the effects of volume-controlled equal ratio ventilation (VC-ERV) and volume-controlled conventionalratio ventilation (VC-CRV) on oxygenation, ventilation, respiratory mechanics, and hemodynamic status during mechanical ventilationwith recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy.Materials and methods: A total of 111 patients scheduled for laparoscopic sleeve gastrectomy were randomized to ventilation withinspiratory to expiratory ratio of 1:1 (Group VC-ERV) or 1:2 (Group VC-CRV) following tracheal intubation. RM (40 cmH2O, 15 s) andPEEP (10 cmH2O) were administered to all patients. Arterial blood gas samples were taken and peak airway pressure (Ppeak), meanairway pressure (Pmean), dynamic compliance (Cdyn), mean arterial pressure, heart rate, SpO2, and EtCO2 were recorded at 4 timepoints. Postoperative respiratory complications were recorded.Results: Oxygenation, ventilation, Pmean levels, and hemodynamic variables were similar in both groups. VC-ERV significantlydecreased Ppeak and increased Cdyn compared to VC-CRV at all time points of the operation (P < 0.05). No pulmonary complicationwas observed in any patients.Conclusion: VC-ERV provides significantly lower Ppeak and higher Cdyn with similar oxygenation, ventilation, hemodynamicparameters, and Pmean levels when compared to VC-CRV during mechanical ventilation with RM and PEEP in laparoscopic sleevegastrectomy.