Assisted pressure control ventilation via a mini-tracheostomy tube for postoperative respiratory management of lung cancer patients

Assisted pressure control ventilation (PCV) via a min-tracheostomy tube (MT T) was conducted to improve gas exchange and reduce the work of breathing o f lung cancer patients after surgery. Thirty-two patients with lung cancer underwent Lobectomy and were managed p ostoperatively by assisted PCV via an MTT. On the basis of a simulation stu dy using a lung model for clinical use, we set the inspiratory pressure to 20 cmH(2)O and inspiratory time to 1.0 sec to produce a 450-ml supported vo lume via the MTT per breath. The blood gases and respiratory rate of each p atient were measured under three sets of conditions: PCV via an MTT transtr acheal oxygenation (TTO) via an MTT and a Venturi face mask with the same F iO(2). After PCV via an MTT overnight, the blood gases in the room air were measured 2.5 h after withdrawing PCV. In order to determine the effect of PCV via an MTT on gas exchange after PCV withdrawal, 32 other age and sex-m atched lung cancer patients. who had undergone lobectomy and oxygenation vi a a face mask alone after surgery, were used as historical controls. The simulation study showed that the ventilated volume provided by assisted PCV via an MTT was about half that provided via a conventional endotrachea l tube, even in the presence of air leakage. The clinical application showe d that the ventilated volume obtained with the PCV via an MTT was significa ntly higher than that with spontaneous breathing (P<0.001). PCV via an MTT increased the PaO2 and reduced both the PaCO2 and respiratory rate signific antly in comparison with TTO via an MTT and a face mask (P<0.001). After PC V withdrawal the morning after surgery, the PaO2 of the PCV group was signi ficantly higher than that of the historical controls (P < 0.001). No postop erative pulmonary complications were observed in either the PCV or the cont rol groups, however. In addition, no complications or morbidity were seen r elated to either MTT insertion or PCV via an MTT. Assisted PVC via an MTT increased the tidal volume, improved the gas exchan ge, reduced the respiratory rate by providing adequate ventilatory support and increased the PaO2, even after withdrawal following lung surgery. Even though we did not observe any benefit of clinical outcome with PCV via an M TT in the present study, this procedure appears to be a potentially useful respiratory management modality for patients with high risk of postoperativ e pulmonary complications.