Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy

Şen, Öznur; Döventaş, Yasemin Erdoğan

doi:10.1016/j.bjane.2015.08.015

Cited by 16 publications

(20 citation statements)

References 17 publications

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“…Two small RCTs have found that 10 cm H 2 O PEEP may confer additional physiologic benefit 6061. With regard to PPCs, a large retrospective study of more than 11 000 abdominal and intracranial operations showed an association between the use of at least 5 cm H 2 O PEEP and a significantly decreased odds of PPCs compared with less than 5 cm H 2 O PEEP (odds ratio 0.72, 0.61 to 0.85) 62.…”

Section: Evidence Based Strategies For Perioperative Lung Protective mentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.

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Section: Evidence Based Strategies For Perioperative Lung Protective mentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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“…Contrary to these results, another study which conducted on laparoscopic cholecystectomy has suggested that 10 peeps increase oxygenation compared to 5 peeps but do not cause any hemodynamic disturbance (27). PEEP levels that result in an increase of driving pressure were also related with more postoperative pulmonary complications (28).…”

Section: Resultsmentioning

confidence: 91%

Cerebral oxygenation and its relation with blood gases and haemodynamic parameters in laparoscopic cholecystectomy with 5 cmH2O PEEP

2020

Deu Med J

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Objective: Pneumoperitoneum application during abdominal surgeries can have negative effects on haemodynamic and respiratory parameters. Cerebral oxygenation level is influenced by many factors; the partial arterial CO 2 pressure (PaCO 2 ) level is the main determinant factor among them. We investigated the effects of CO 2 insufflation and the head-up position on haemodynamic parameters and cerebral oxygenation levels during laparoscopic cholecystectomy with the application of 5cm H 2 O positive end-expiratory pressure (PEEP).Materials and Methods: Forty patients, between 18-65 of age, with an ASA physical status of I-II were included in the study. Following anaesthesia induction, 5 cm H 2 O PEEP was applied and CO 2 was insufflated into the abdominal space. Patients were operated in the 15° head-up position.Results: Mean cardiac output was observed to be significantly higher after desufflation (5.80 ± 1.39) in comparison to the initial values prior to the pneumoperitoneum application (5.08 ± 0.95), (p< 0.05). There was no significant change in other haemodynamic parameters or cerebral oxygenation levels. PaCO 2 and end-tidal CO 2 (EtCO 2 ) levels significantly increased during the pneumoperitoneum period (PaCO 2 = 33.37 ± 4.97, 36.77 ± 3.91, and 39.35 ± 3.51 mmHg, and EtCO 2 = 31.52 ± 2.80, 33.95 ± 3.38, and 35.72 ± 2.92 mm Hg; before, at 5 and 20 min after insufflation respectively; p < 0.05). Conclusion:Application of 5 cm H 2 O PEEP does not improve the cerebral oxygenation but may contribute to preservation of baseline values with stable haemodynamic status after insufflation during laparoscopic cholecystectomy. Fluid administering strategy and use of opioids are important factors to achieve stable haemodynamic condition. In addition, mildly increased PaCO 2 levels may contribute to preserving cerebral oxygenation.

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“…4,5 PEEP has been advocated by various authors to improve oxygenation, prevent atelectasis and related postoperative complications. 6,7 On the other hand some trials 8 concluded that high PEEP and lung recruitment did not afford any protection against pulmonary complications. There seems to be no agreement among different authors regarding optimal PEEP value.…”

Section: Discussionmentioning

confidence: 99%

“…8 On the other hand some studies showed no hemodynamic instability after giving PEEP. 7,10,14 Though PEEP did not demonstrate significant hemodynamic consequences in many studies, it is worth noting that all these studies were done on otherwise healthy patients from cardiac point of view. We recommend judicious use of PEEP titrated to minimum hemodynamic derangement, particularly in patients with preexisting cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Comparison of ventilation with and without positive end expiratory pressure during anesthesia for laparoscopic surgeries

Saundattikar¹,

Dongare²,

Gupta³

2021

IJCA

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Background: Respiratory dynamics are significantly altered during laparoscopic surgeries. Anesthesiologists should be well versed with the benefits as well as limitations of positive end expiratory pressure (PEEP) during laparoscopy. They can then judiciously use the same in different patient populations. In this study we have compared the effects of ventilation with and without PEEP of 10 cm on blood gases, airway pressures and hemodynamic parameters during laparoscopy. Materials and Methods: 60 patients, from American Society of Anesthesiologists (ASA) physical status I and II, in the age group of 18 to 60, posted for laparoscopic cholecystectomy were enrolled. They were randomized into two groups of 30 each. Group P received PEEP of 10 cm during laparoscopy and group C did not receive any PEEP. The vital parameters, arterial blood gases, and airway pressures were compared in both groups. Results: The oxygenation, (PaO2/FiO2 ratio) was significantly higher in PEEP group (446. 4 ± 113.32 mm of Hg) as compared to the control group (404 ± 51.4 mm of Hg) after one hour of laparoscopy (P= 0.0037). The control group had higher arterial carbon dioxide tension (42.84 ± 2.38 mm of Hg) as compared to PEEP group (41.86 ± 2.33 mm of Hg), (P < 0.001). Both the findings suggest better ventilation perfusion matching in PEEP group. There was a no significant variation in mean arterial pressure and heart rate due to PEEP in our patient population. However the peak airway pressures were significantly higher in PEEP group. Conclusion: 10 cm of PEEP helped in better oxygenation with no significant hemodynamic alterations, in otherwise healthy patients undergoing laparoscopic cholecystectomy.

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Effects of different levels of end-expiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy

Abstract: Ventilation with 10cmHO PEEP increases compliance and oxygenation, does not cause hemodynamic and respiratory complications and reduces the postoperative stress response.

Cited by 16 publications

References 17 publications

Perioperative lung protective ventilation

Perioperative lung protective ventilation

Cerebral oxygenation and its relation with blood gases and haemodynamic parameters in laparoscopic cholecystectomy with 5 cmH2O PEEP

Comparison of ventilation with and without positive end expiratory pressure during anesthesia for laparoscopic surgeries

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