The effects of adaptive pressure ventilation–synchronised intermittent mandatory ventilation and pressure-controlled synchronised intermittent mandatory ventilation on pulmonary mechanics and arterial gas analyses during laparoscopic cholecystectomy
Bibliographic record
Abstract
Hypercapnia and elevated intraabdominal pressure from carbon dioxide (CO 2 ) pneumoperitoneum can adversely affect respiratory mechanics and arterial blood gases. We tested the hypothesis that adaptive pressure ventilation–synchronised intermittent mandatory ventilation (APV-SIMV) may provide better pulmonary mechanics, CO 2 homeostasis and pulmonary gas exchanges with less frequent ventilatory settings (tidal volume (TV), respiratory rate (RR)) and lower peak inspiratory pressure ( P peak ) and plateau pressure ( P plat ) than pressure-controlled synchronised intermittent mandatory ventilation (P-SIMV) in patients undergoing laparocopic cholecystectomy (LP). The study group consisted of 40 patients (APV-SIMV n = 20, P-SIMV n = 20). LP was performed under total intravenous anesthesia. After induction of anesthesia, a RR of 12 breaths/minute, and an inspiratory:expiratory rate of 1:2 and PEEP of 6 cmH 2 O were set for both groups. APV-SIMV was started with a target TV of 8 ml/kg. P-SIMV was started with the inspiratory pressure ( P ins ) that will provide 8 ml/kg TV. The settings were changed until target parameters to maintain normocapnia and normoxia were achieved (ETCO 2 30–35 mmHg, PaCO 2 35–45 mmHg and SaO 2 >90%). When the target parameters could not be achieved, the first RR was increased by 2 breaths/minute up to 16 breaths/minute, then the volume or pressure was titrated to induce 1 ml/kg increases in TV up to 10 ml/kg. The initial FiO 2 was set to 50%. FiO 2 was increased with increments when the SaO 2 fell below 90%. PaO 2 /FiO 2 , static compliance, VD/VT, P peak and P plat , ETCO 2 , inspiratory and expiratory resistances, and arterial blood gas analysis were recorded before, during and after pneumoperitoneum. Statistical analysis were carried out using the chi-square test, paired test and independent samples test when appropriate. Demographic data were similar between groups. Pneumoperitoneum caused significant decreases in static compliance and arterial pH, and increases in P peak and P plat , VD/VT and ETCO 2 in both groups. However, APV-SIMV resulted in fewer setting changes, lower peak and plateau pressures, VD/VT, and ETCO 2 levels when compared with P-SIMV ( P < 0.025). APV-SIMV may provide better results then conventional P-SIMV in patients undergoing LP.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".