Comparison of Positive End-Expiratory Pressure versus Tidal Volume-Induced Ventilator-Driven Alveolar Recruitment Maneuver in Robotic Prostatectomy: A Randomized Controlled Study

Jung, Kangha; Kim, Sojin; Kim, Byung Jun; Park, MiHye

doi:10.3390/jcm10173921

Cited by 3 publications

(5 citation statements)

References 25 publications

(35 reference statements)

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“…It demands a close communication and cooperation with the surgeons. Some studies do mention this severe technical limitation [9,11,12,21,22], but it is quite uncertain how other researchers dealt with this issue.…”

Section: Discussionmentioning

confidence: 99%

“…The mentioned studies [7,[9][10][11][12][13]16,21,22] relate to the use of EIT during laparoscopic surgery with capnoperitoneum. The studies [21,22] used the cranial position of the electrode belt and following studies highlighted technical limitations, such as electromagnetic incompatibility with the ESU [9,11,12,21,22] and the presence of the diaphragm in the standard position of the electrode belt [7,16].…”

Section: Discussionmentioning

confidence: 99%

“…It is a radiation-free, noninvasive, portable technique imaging the distribution of ventilation. Several studies [8][9][10][11][12][13] used EIT to monitor the lungs during capnoperitoneum for the purpose of analyzing regional ventilation changes and the effect of positive end-expiratory pressure (PEEP) changes. They all used a standardly placed electrode belt as recommended by the manufacturers of the EIT systems.…”

Section: Introductionmentioning

confidence: 99%

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Cranial Electrode Belt Position Improves Diagnostic Possibilities of Electrical Impedance Tomography during Laparoscopic Surgery with Capnoperitoneum

Koldova,

Rara,

Muller

et al. 2023

Sensors

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Laparoscopic surgery with capnoperitoneum brings many advantages to patients, but also emphasizes the negative impact of anesthesia and mechanical ventilation on the lungs. Even though many studies use electrical impedance tomography (EIT) for lung monitoring during these surgeries, it is not clear what the best position of the electrode belt on the patient’s thorax is, considering the cranial shift of the diaphragm. We monitored 16 patients undergoing a laparoscopic surgery with capnoperitoneum using EIT with two independent electrode belts at different tomographic levels: in the standard position of the 4th–6th intercostal space, as recommended by the manufacturer, and in a more cranial position at the level of the axilla. Functional residual capacity (FRC) was measured, and a recruitment maneuver was performed at the end of the procedure by raising the positive end-expiratory pressure (PEEP) by 5 cmH2O. The results based on the spectral analysis of the EIT signal show that the ventilation-related impedance changes are not detectable by the belt in the standard position. In general, the cranial belt position might be more suitable for the lung monitoring during the capnoperitoneum since the ventilation signal remains dominant in the obtained impedance waveform. FRC was significantly decreased by the capnoperitoneum and remained lower also after desufflation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cranial Electrode Belt Position Improves Diagnostic Possibilities of Electrical Impedance Tomography during Laparoscopic Surgery with Capnoperitoneum

Koldova,

Rara,

Muller

et al. 2023

Sensors

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“…5 cmH 2 O) did not affect the intraoperative respiratory mechanics but was associated with a slightly lower incidence of postoperative pulmonary complications [12]. Regarding the lung recruitment technique, at a similar plateau pressure level, increasing PEEP significantly improved the oxygenation and the end-expiratory lung gas volume compared with increasing tidal volume [13 ▪▪ ].…”

Section: Ventilatory Managementmentioning

confidence: 99%

The intraoperative management of robotic-assisted laparoscopic prostatectomy

Chiumello,

Fratti,

Coppola

2023

Current Opinion in Anaesthesiology

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Purpose of review Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy. Recent findings Surgical innovations and the advent of new technologies make it imperative to optimize the anesthesia management to provide the most holistic approach possible. In addition, an ageing population with an increasing burden of comorbidities requires multifocal attention to reduce the surgical stress. Summary Total intravenous anesthesia (TIVA) and balanced general anesthesia are similar in terms of postoperative complications and hospital stay. Reversal of rocuronium is associated with shorter hospital stay and postanesthesia recovery time. Adequate PEEP levels improve oxygenation and driving pressure, and the use of a single recruitment maneuver after the intubation reduces postoperative pulmonary complications. Restrictive intravenous fluid administration minimizes bladder–urethra anastomosis complications and facial edema. TIVA maintains a better autoregulation compared with balanced general anesthesia. Anesthesiologists should be able to optimize the intraoperative management to improve outcomes.

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“…Four horizontal parallel regions of interest (ROIs) within the chest contour were selected: ROI 1 (ventral), ROI 2 (central ventral), ROI 3 (central dorsal), and ROI 4 (dorsal). To evaluate ventilation distribution, the number calculated per ROI is the sum of impedance changes in this ROI in relation to the sum of impedance changes of the whole EIT image [18]. EIT data were continuously recorded and analyzed offline using the Dräger EIT analysis tool, version 6.1 (Dräger Medical) [19].…”

Section: Eit Measurementsmentioning

confidence: 99%

Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease

Liu

Liu²,

Meng

et al. 2022

Crit Care

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Background Chronic obstructive pulmonary disease (COPD) is one of most common comorbidities in acute respiratory distress syndrome (ARDS). There are few specific studies on the appropriate ventilation strategy for patients with ARDS comorbid with COPD, especially regarding on positive end-expiratory pressure (PEEP) titration. Methods To compare the respiratory mechanics in mechanical ventilated ARDS patients with or without COPD and to determine whether titration of PEEP based on electrical impedance tomography (EIT) is superior to the ARDSnet protocol. This is a single center, perspective, repeated measure study. ARDS patients requiring mechanical ventilation who were admitted to the intensive care unit between August 2017 and December 2020 were included. ARDS patients were divided according to whether they had COPD into a COPD group and a non-COPD group. Respiratory mechanics, gas exchange, and hemodynamics during ventilation were compared between the groups according to whether the PEEP level was titrated by EIT or the ARDSnet protocol. Results A total of twenty-seven ARDS patients including 14 comorbid with and 13 without COPD who met the study eligibility criteria were recruited. The PEEP levels titrated by EIT and the ARDSnet protocol were lower in the COPD group than in the non-COPD group (6.93 ± 1.69 cm H2O vs. 12.15 ± 2.40 cm H2O, P < 0.001 and 10.43 ± 1.20 cm H2O vs. 14.0 ± 3.0 cm H2O, P < 0.001, respectively). In the COPD group, the PEEP level titrated by EIT was lower than that titrated by the ARDSnet protocol (6.93 ± 1.69 cm H2O vs. 10.43 ± 1.20 cm H2O, P < 0.001), as was the global inhomogeneity (GI) index (0.397 ± 0.040 vs. 0.446 ± 0.052, P = 0.001), plateau airway pressure (16.50 ± 4.35 cm H2O vs. 20.93 ± 5.37 cm H2O, P = 0.001), dead space ventilation ratio (48.29 ± 6.78% vs. 55.14 ± 8.85%, P < 0.001), ventilation ratio (1.63 ± 0.33 vs. 1.87 ± 0.33, P < 0.001), and mechanical power (13.92 ± 2.18 J/min vs. 15.87 ± 2.53 J/min, P < 0.001). The cardiac index was higher when PEEP was treated by EIT than when it was titrated by the ARDSnet protocol (3.41 ± 0.50 L/min/m2 vs. 3.02 ± 0.43 L/min/m2, P < 0.001), as was oxygen delivery (466.40 ± 71.08 mL/min/m2 vs. 411.10 ± 69.71 mL/min/m2, P = 0.001). Conclusion Titrated PEEP levels were lower in patients with ARDS with COPD than in ARDS patients without COPD. In ARDS patient comorbid with COPD, application of PEEP titrated by EIT was lower than those titrated by the ARDSnet protocol, which contributed to improvements in the ventilation ratio, mechanical energy, cardiac index, and oxygen delivery with less of an adverse impact on hemodynamics.

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Comparison of Positive End-Expiratory Pressure versus Tidal Volume-Induced Ventilator-Driven Alveolar Recruitment Maneuver in Robotic Prostatectomy: A Randomized Controlled Study

Cited by 3 publications

References 25 publications

Cranial Electrode Belt Position Improves Diagnostic Possibilities of Electrical Impedance Tomography during Laparoscopic Surgery with Capnoperitoneum

Cranial Electrode Belt Position Improves Diagnostic Possibilities of Electrical Impedance Tomography during Laparoscopic Surgery with Capnoperitoneum

The intraoperative management of robotic-assisted laparoscopic prostatectomy

Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease

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