Abstract
OBJECTIVE: To compare mechanical power (MP) levels among flow-controlled ventilation (FCV), volume-controlled ventilation (VCV), and pressure-controlled volume-guaranteed ventilation (PCV-VG) during laparoscopic surgery and to test the hypothesis that the stable flow dynamics of FCV would reduce MP. METHODS: Patients were divided into three groups according to the mechanical ventilation modes applied during laparoscopic surgery: PCV-VG (n=15), VCV (n=14), and FCV (n=15). MP was calculated at four timepoints: baseline (T1), post-induction (T2), during CO(2) insufflation (T3), and post-insufflation (T4). The primary outcome of the study was the comparison of MP in the FCV mode with MP in the other groups during insufflation. Driving pressure (DP), plateau pressure, and peak airway pressure were also analyzed. RESULTS: Baseline MP was highest in PCV-VG (6.9 J/min vs. 5.0 J/min in VCV and 5.1 J/min in FCV; p=0.002). During insufflation (T3), MP increased to a similar extent across groups (PCV-VG: 9.4 J/min, VCV: 8.7 J/min, FCV: 8.6 J/min), with PCV-VG showing the smallest relative rise (p<0.001). DP and plateau pressures increased during pneumoperitoneum, but Bonferroni-adjusted comparisons revealed that these were not statistically significant. PCV-VG maintained higher positive end-expiratory pressure (5 vs. 4 cmH(2)O, p<0.001); however, it did not significantly affect peak pressures. CONCLUSIONS: Contrary to our hypothesis, FCV did not reduce MP more effectively than either VCV or PCV-VG. However, PCV-VG demonstrated better mitigation of insufflation-induced increases in MP, suggesting potential advantages for lung protection during laparoscopy. Further prospective studies are needed to assess clinical outcomes.