Effect of pressure-controlled ventilation-volume guaranteed mode on intraoperative respiratory mechanics, oxygenation and postoperative pulmonary complications: a systematic review and network meta-analysis

Ventilation strategies during general anesthesia are crucial for optimizing respiratory mechanics, ensuring adequate oxygenation, and minimizing postoperative pulmonary complications (PPCs) in surgical patients. This systematic review and network meta-analysis (NMA) aim to evaluate the effect of pressure controlled volume guaranteed ventilation (PCV-VG) in patients undergoing non-cardiothoracic surgery. We selected randomized controlled trials (RCTs) to explore the effect of PCV-VG mode on intraoperative respiratory mechanics, oxygenation and PPCs in surgical patients published in English by searching PubMed, Embase, Web of Science, and the Cochrane from inception to May 2025. The primary outcome was dynamic lung compliance (Cdyn). Fourteen studies with 2263 patients were included. Compared to volume-controlled ventilation (VCV), PCV-VG had higher Cdyn and lower airway peak pressure (Ppeak). For tidal volume (Vt), partial pressure of carbon dioxide in arterial blood (PaCO₂), partial pressure of oxygen in arterial blood (PaO₂), oxygenation index (OI), airway mean pressure (Pmean), and PPCs, there were no significant difference among pressure-controlled ventilation (PCV), VCV, and PCV-VG. Compared to VCV, PCV-VG did not significantly affect the values of potential of hydrogen (pH) and partial pressure of end-tidal carbon dioxide (PetCO₂). The subgroup analysis only showed that PCV had higher Cdyn than VCV in prone position. PCV-VG was superior to VCV in Cdyn and Ppeak, PCV only achieved higher Cdyn than VCV for prone position. The three modes did not differ in Vt, Pmean, PetCO_2, pH, PaCO₂, PaO₂, OI, and PPCs for patients undergoing non-cardiothoracic surgery. We evaluate the effect of pressure controlled volume guaranteed ventilation (PCV-VG) on on intraoperative respiratory mechanics, oxygenation and postoperative pulmonary complications.PCV-VG results in significantly higher Cdyn and lower Ppeak compared to VCV.PCV-VG, PCV, and VCV did not have significant impacts on Vt, PaCO₂, PaO₂, OI, Pmean, and PPCs. We evaluate the effect of pressure controlled volume guaranteed ventilation (PCV-VG) on on intraoperative respiratory mechanics, oxygenation and postoperative pulmonary complications. PCV-VG results in significantly higher Cdyn and lower Ppeak compared to VCV. PCV-VG, PCV, and VCV did not have significant impacts on Vt, PaCO₂, PaO₂, OI, Pmean, and PPCs.