Pressure controlled ventilation with volume guarantee improves outcomes in neonatal thoracoscopic esophageal atresia surgery.

Introduction: Neonatal thoracoscopic repair of esophageal atresia requires one-lung ventilation (OLV), which poses challenges due to immature lung development and low compliance, increasing risks of hypoxemia and barotrauma. While volume-controlled ventilation (VCV) ensures stable tidal volume, it may cause excessive airway pressures, whereas pressure-controlled ventilation (PCV) lacks volume guarantee. This study compared PCV with volume guarantee (PCV-VG) and conventional VCV to improve respiratory outcomes during OLV.

Methods: A retrospective analysis was conducted on neonates (aged 1-7 days) undergoing thoracoscopic esophageal atresia repair with OLV. Patients were categorized into PCV-VG and VCV groups. Respiratory parameters (PaO, PaCO, airway pressures, dynamic compliance) were measured before, during, and after OLV. Propensity score matching (PSM) was used to balance baseline characteristics.

Results: After PSM, 74 neonates (37 per group) were included. During OLV, the PCV-VG group exhibited significantly lower PaCO, peak/mean airway pressures, and higher dynamic compliance compared to the VCV group (all  < 0.05). Postoperatively, PCV-VG was associated with shorter mechanical ventilation duration, ICU stay, and hospital stay ( < 0.05). Postoperative complication rates did not differ between groups ( > 0.05).

Conclusion: PCV-VG offers superior ventilation parameters and faster recovery in neonatal thoracoscopic esophageal atresia repair, though it does not affect postoperative complication rates.