The effects of Pressure-Controlled Volume-Guaranteed ventilation (PCV-VG) on Postoperative Pulmonary Complications (PPCs) of oral and maxillofacial patients undergoing free flap reconstruction: a randomized controlled trial.

The borderline significance of the primary outcome ( P = 0.051) may reflect insufficient power for subgroup interactions, though the tracheotomy-specific effect reached statistical significance.

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While the primary outcome of overall PPCs reduction showed a strong trend without reaching conventional statistical significance (26.7% vs. 34.2%, P = 0.051), we observed clinically important improvements in several key areas: significantly better intraoperative respiratory mechanics with lower peak inspiratory pressures and improved dynamic compliance, superior oxygenation parameters, a statistically significant reduction in hospital length of stay (9 vs. 10 days, P = 0.041), and most notably, a substantial reduction in PPCs incidence among tracheotomy patients (30.8% vs. 45.3%, P = 0.032).

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Conclusions For patients undergoing oral and maxillofacial surgery with free flap reconstruction who were at intermediate or high risk of developing PPCs, PCV-VG could shorten the length of stay in hospital and showed a trend toward being superior to VCV in its ability to provide ventilation with lower peak inspiratory pressure, greater dynamic compliance, and better oxygenation.

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This 7.5% absolute risk reduction approached but did not reach statistical significance and aligned with our pre-trial hypothesis of PCV-VG’s lung-protective benefits.

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