Evaluating the Effect of Pressure-Controlled Versus Volume-Controlled Ventilation Modes on Intraoperative Bleeding in Rhinoplasty: A Randomized Clinical Trial.

Background: Intraoperative bleeding is one of the major challenges in rhinoplasty.

Objectives: This study aimed to evaluate the effect of pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) modes on intraoperative bleeding during rhinoplasty.

Methods: In a double-blinded randomized clinical trial, 58 candidates for rhinoplasty were randomly assigned to the PCV or VCV groups. Anesthesia was induced and maintained using the same total intravenous anesthesia (TIVA) method in both groups. The amount of bleeding was assessed by counting blood-soaked gauze and measuring the content of the suctioned fluid. Additionally, bleeding in the surgical field was assessed by the surgeon using the Boezaart criterion.

Results: The mean intraoperative bleeding volume was 30 ± 45 mL in the PCV group and 100 ± 120 mL in the VCV group (P < 0.001). According to logistic regression analysis, the odds of experiencing moderately severe or severe bleeding in the VCV group were 5.4 times higher than in the PCV group. After adjusting for confounding variables, the odds ratio increased to 26.8 (95% CI = 1.2, 59.3).

Conclusions: The results of the study suggest that the pressure-controlled mode may lead to lower intraoperative bleeding compared to the volume-controlled mode. The decrease in peak airway pressure is likely a contributing factor to this observation.