Only the patients remained blinded during the whole study procedure. Researchers at the Teikyo Academic Research Centre randomized the patients to the VCV (n = 14) or PC-IRV groups (n = 14) with a 1:1 allocation ratio using the envelope method, after generating the allocation sequence. Written informed consent was obtained from all qualifying patients. The exclusion criteria were ASA physical status 3–5, and/or a history of pneumothorax and lung surgery. Patients aged 18–85 years with American Society of Anesthesiologists (ASA) physical status I or II and scheduled for robot-assisted laparoscopic radical prostatectomy were included in this study. Takigawa) on 12 September 2017, and the trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000029552). 17–063) was obtained from the Ethical Committee of Teikyo University School of Medicine, Tokyo, Japan (Chairperson and Dean: H. Ethical approval for this randomized controlled trial (No. This study was a secondary analysis of a previously published single-center, prospective, single-blinded, randomized controlled trial. We hypothesized that PC-IRV reduces dead space and improves mismatch, and that PC-IRV may be an alternative to the open-lung approach for ventilation. We studied the changes in dead space components induced by PC-IRV and the elapsed time and aimed to evaluate the ventilation-perfusion characteristics of PC-IRV and VCV modes and their sustainability. Each dead space component represents a respective mismatch, enabling us to understand the heterogeneity and elapsed time changes of mismatch, which would contribute to practicing the open-lung approach for ventilation. Using volumetric capnography, the VD phys is divided into three dead space components: airway dead space (VD aw), alveolar dead space (VD alv), and shunt dead space (VD shunt). PC-IRV or pressure-controlled ventilation with sufficient inspiratory time might reduce the VD phys.
VD phys represents the overall ventilatory efficiency, including circulatory dynamics, and a total of ventilation/perfusion ( ) mismatch.
However, serum cytokine levels are affected not only by the ventilator setting, but also by duration, surgical invasion, bleeding, and any stress to the patient. However, another randomized controlled study reported no differences between the lung-protective properties of PC-IRV and volume-control ventilation (VCV) when performed for >2 h in robot-assisted laparoscopic radical prostatectomy, as determined by the changes in serum cytokine levels. We believe that PC-IRV might be a lung-protective ventilation strategy. Previously, we studied the changes in dead space components within a short duration (30 min) of each ventilator mode using a cross-over study design, and reported that pressure-controlled inverse ratio ventilation (PC-IRV) reduces the physiological dead space (VD phys).
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