A study found that a specific ventilation mode protects the lungs during surgery better than traditional methods, though clinical outcomes remained similar.


RT’s Three Key Takeaways:

  1. Improved Respiratory Mechanics: Patients receiving pressure control-volume guarantee (PCV-VG) ventilation demonstrated higher respiratory system compliance and lower driving pressure compared to those on volume control ventilation.
  2. Postoperative Complications: While PCV-VG showed a numerical reduction in postoperative pulmonary complication rates, the study was not powered to find a statistically significant clinical difference.
  3. Need for Larger Trials: Researchers suggest that larger multicenter trials are necessary to determine if the intraoperative physiological benefits of PCV-VG lead to improved recovery and reduced mortality in high-risk patients.


Pressure control-volume guarantee (PCV-VG) ventilation improved intraoperative respiratory mechanics but did not significantly reduce postoperative pulmonary complications (PPCs) compared with conventional volume control ventilation (VCV) in patients undergoing emergency abdominal surgery, according to a randomized controlled trial published in Surgery.

Patients undergoing emergency laparotomy are at high risk of developing PPCs, which are associated with prolonged hospital stays, increased healthcare costs, and higher mortality. Optimizing intraoperative ventilation has become an important strategy for reducing lung injury during surgery. PCV-VG combines the pressure-limiting benefits of pressure-controlled ventilation with the delivery of a guaranteed tidal volume, potentially improving lung protection while maintaining adequate ventilation.

Researchers conducted a single-center randomized controlled trial involving 106 adults undergoing emergency laparotomy expected to last more than two hours under general anesthesia. Participants were randomly assigned to receive either PCV-VG or conventional VCV throughout surgery. The primary outcome was the development of PPCs within seven days, assessed using the Melbourne Group Score version 2 (MGS-2).

Secondary outcomes included respiratory mechanics during surgery, lung aeration assessed by ultrasound, oxygenation, hospital length of stay, oxygen-free days, and mortality.

One hour after surgery began, patients receiving PCV-VG demonstrated significantly improved respiratory mechanics compared with those receiving conventional ventilation. Respiratory system compliance was higher, while both driving pressure and mechanical power—two measures associated with ventilator-induced lung injury—were lower in the PCV-VG group, according to the study.

These findings suggest the ventilation mode may reduce mechanical stress on the lungs during surgery by delivering tidal volumes more efficiently while limiting airway pressures. However, oxygenation and lung aeration scores were similar between the two groups.

Despite the physiological improvements observed during surgery, the primary clinical outcome did not differ significantly between groups. Median PPC scores were comparable, and statistical analysis found no significant reduction in overall PPC rates with PCV-VG.

Using the MGS-2 definition, PPCs occurred in 3.8% of patients receiving PCV-VG compared with 17% of those receiving VCV. Although this numerical difference favored PCV-VG, the study authors noted the study was not powered to determine whether this reflected a true clinical benefit. Other patient-centered outcomes, including oxygen-free days, hospital length of stay, and mortality, were also similar between groups.

The authors concluded that PCV-VG offers measurable physiological advantages during emergency laparotomy by improving respiratory system mechanics and reducing driving pressure and mechanical power. However, these improvements did not translate into a statistically significant reduction in PPCs in this study.

The researchers noted that the relatively small sample size may have limited their ability to detect differences in clinical outcomes. They suggested that larger multicenter trials are now needed to determine whether the intraoperative benefits of PCV-VG ultimately improve postoperative recovery and reduce pulmonary complications in higher-risk surgical populations.


Reference

Jassal N et al. Volume Control Ventilation versus Pressure Control- Volume Guarantee Ventilation in Emergency Surgery: A Randomized Controlled Trial. Surgery. 2026; 10.1016/j.surg.2026.110438.

This article was originally published by AMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.