Effect of target-controlled pressure-controlled ventilation on percutaneous nephrolithotripsy patients under general anesthesia: a retrospective study.

BACKGROUND: Prone position surgery tends to limit chest wall mobility with decreased compliance and increased airway pressure, which can increase the incidence of postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure. There is a lack of guidelines recommending mechanical ventilation parameters in prone position surgery. The present study aimed to investigate the effect of pressure-controlled ventilation (PCV) with end-inspiratory flow rate as the target on percutaneous nephrolithotripsy patients under general anesthesia in the prone position.

METHODS: From January 2020 to December 2021, a total of 154 patients admitted to Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCM were retrospectively enrolled. All patients received percutaneous nephrolithotripsy. According to the type of mechanical ventilation given during surgery, the patients were divided into a fixed-respiration-ratio-PCV group (n=78) and a target-controlled-PCV group (n=76). The hemodynamics, postoperative pulmonary complications (PPCs), and serum inflammation levels between the two groups were compared.

RESULTS: The overall incidence of PPCs was significantly lower in the target-controlled-PCV group than in the fixed-respiration-ratio-PCV group (3.95% vs. 14.10%, P=0.028). There were no significant differences in peak airway pressure, airway plateau pressure, or dynamic lung compliance at T0 (P>0.05). However, at T1, T2, and T3, the peak airway pressure and airway platform pressure in the target-controlled-PCV group were significantly reduced (P<0.05), and the dynamic pulmonary compliance was significantly increased (P<0.05) compared with the fixed-respiration-ratio group. There was no significant difference in preoperative interleukin 6 (IL-6) and C-reactive protein (CRP) levels between the two groups (P>0.05). IL-6 and CRP levels at 1 and 3 days postoperatively were significantly reduced in the target-controlled-PCV group compared with the fixed-respiration-ratio-PCV group (P<0.05).

CONCLUSIONS: Pressure-controlled ventilation with end-inspiratory flow rate as the target can reduce postoperative pulmonary complications and inflammatory levels in patients undergoing percutaneous nephrolithotripsy under general anesthesia in the prone position.