TY - JOUR T1 - Evaluation of lung protective property of expiratory flow initiated pressure-controlled inverse ratio ventilation in robot-assisted laparoscopic radical prostatectomy JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2019.PA2261 VL - 54 IS - suppl 63 SP - PA2261 AU - Go Hirabayashi AU - Minami Saito AU - Sachiko Terayama AU - Hiroko Nishioka AU - Koichi Maruyama AU - Tomio Andoh Y1 - 2019/09/28 UR - http://erj.ersjournals.com/content/54/suppl_63/PA2261.abstract N2 - Background: We have shown that expiratory flow initiated pressure-controlled inverse ratio ventilation (EF initiated PC-IRV) reduces physiological dead space (VDphys).Objective: To evaluate lung protection with EF initiated PC-IRV.Design: A randomised controlled trial.Patients: 28 consecutive subjects undergoing robot-assisted laparoscopic radical prostatectomy.Interventions: EF initiated PC-IRV strategy (n=14) includes pressure control ventilation volume guarantee (PCV-VG) mode, VT setting of 6–10 ml/kg so that plateau pressure ≤ 30 cmH2O. I/E ratio was adjusted to initiate inflation at the midpoint between the expiratory flow change point and the return point to the expected baseline. Volume control ventilation (VCV) strategy (n=14) includes VCV mode, pause ratio of 20%, I/E ratio of 1/2, VT setting of 6–10 ml/kg so that plateau pressure ≤ 30 cmH2O. Hypercapnia (>50 mmHg) was permitted at the maximum RR of 18 bpm, plateau pressure of 30 cmH2O. Serum IL-6 levels were measured at the end of surgery.Results: There were no significant differences in serum IL-6 after surgery between PC-IRV 34 (10-122) pg/ml and VCV 31 (18-273) pg/ml [median (min - max)].VDphys/VTE ratio in VCV correlated negatively with FVC % predicted. There were 2 permissive hypercapnia cases in VCV, in the cases with low FVC % predicted.VDphys/VTE ratio were reduced in PC-IRV and did not correlated with FVC % predicted. There was no permissive hypercapnia in PC-IRV.Conclusion: EF initiated PC-IRV was useful in low respiratory compliance cases, but its protective effect estimated by systemic IL-6 levels was not evident in this study.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA2261.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -