Positive end-expiratory pressure individualization guided by continuous end-expiratory lung volume monitoring during laparoscopic surgery

2021 ◽  
Author(s):  
Gerardo Tusman ◽  
Mats Wallin ◽  
Cecilia Acosta ◽  
Bruno Santanera ◽  
Facundo Portela ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Volume ◽  
Positive End Expiratory Pressure

scholarly journals Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position

2021 ◽  
Author(s):  
Jianli Li ◽  
Saixian Ma ◽  
Xiujie Chang ◽  
Songxu Ju ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Injury ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Trial Registry ◽  
Positive End Expiratory Pressure ◽  
Clinical Trial Registry ◽  
Trendelenburg Position ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled

AbstractThe study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury.Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928

Body Habitus and Dynamic Surgical Conditions Independently Impair Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery

2020 ◽  
Vol 133 (4) ◽  
pp. 750-763 ◽  
Author(s):  
William G. Tharp ◽  
Serena Murphy ◽  
Max W. Breidenstein ◽  
Collin Love ◽  
Alisha Booms ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Surgery ◽  
Body Mass ◽  
Mechanical Strain ◽  
Lung Mechanics ◽  
Pulmonary Mechanics ◽  
Positive End Expiratory Pressure ◽  
Body Habitus ◽  
Wide Range ◽  
Surgical Conditions

Background Body habitus, pneumoperitoneum, and Trendelenburg positioning may each independently impair lung mechanics during robotic laparoscopic surgery. This study hypothesized that increasing body mass index is associated with more mechanical strain and alveolar collapse, and these impairments are exacerbated by pneumoperitoneum and Trendelenburg positioning. Methods This cross-sectional study measured respiratory flow, airway pressures, and esophageal pressures in 91 subjects with body mass index ranging from 18.3 to 60.6 kg/m2. Pulmonary mechanics were quantified at four stages: (1) supine and level after intubation, (2) with pneumoperitoneum, (3) in Trendelenburg docked with the surgical robot, and (4) level without pneumoperitoneum. Subjects were stratified into five body mass index categories (less than 25, 25 to 29.9, 30 to 34.9, 35 to 39.9, and 40 or higher), and respiratory mechanics were compared over surgical stages using generalized estimating equations. The optimal positive end-expiratory pressure settings needed to achieve positive end-expiratory transpulmonary pressures were calculated. Results At baseline, transpulmonary driving pressures increased in each body mass index category (1.9 ± 0.5 cm H2O; mean difference ± SD; P < 0.006), and subjects with a body mass index of 40 or higher had decreased mean end-expiratory transpulmonary pressures compared with those with body mass index of less than 25 (–7.5 ± 6.3 vs. –1.3 ± 3.4 cm H2O; P < 0.001). Pneumoperitoneum and Trendelenburg each further elevated transpulmonary driving pressures (2.8 ± 0.7 and 4.7 ± 1.0 cm H2O, respectively; P < 0.001) and depressed end-expiratory transpulmonary pressures (–3.4 ± 1.3 and –4.5 ± 1.5 cm H2O, respectively; P < 0.001) compared with baseline. Optimal positive end-expiratory pressure was greater than set positive end-expiratory pressure in 79% of subjects at baseline, 88% with pneumoperitoneum, 95% in Trendelenburg, and ranged from 0 to 36.6 cm H2O depending on body mass index and surgical stage. Conclusions Increasing body mass index induces significant alterations in lung mechanics during robotic laparoscopic surgery, but there is a wide range in the degree of impairment. Positive end-expiratory pressure settings may need individualization based on body mass index and surgical conditions. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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

2021 ◽  
Vol 10 (17) ◽  
pp. 3921
Author(s):  
Kangha Jung ◽  
Sojin Kim ◽  
Byung Jun Kim ◽  
MiHye Park
Keyword(s):  
Laparoscopic Surgery ◽  
Tidal Volume ◽  
Supine Position ◽  
Recruitment Maneuver ◽  
Lung Compliance ◽  
Robotic Prostatectomy ◽  
Alveolar Recruitment ◽  
Driving Pressure ◽  
Positive End Expiratory Pressure ◽  
Alveolar Recruitment Maneuver

Background: We evaluated the pulmonary effects of two ventilator-driven alveolar recruitment maneuver (ARM) methods during laparoscopic surgery. Methods: Sixty-four patients undergoing robotic prostatectomy were randomized into two groups: incrementally increasing positive end-expiratory pressure in a stepwise manner (PEEP group) versus tidal volume (VT group). We performed each ARM after induction of anesthesia in the supine position (T1), after pneumoperitoneum in the Trendelenburg position (T2), and after peritoneum desufflation in the supine position (T3). The primary outcome was change in end-expiratory lung impedance (EELI) before and 5 min after ARM at T3, measured by electrical impedance tomography. Results: The PEEP group showed significantly higher increasing EELI 5 min after ARM than the VT group at T1 and T3 (median [IQR] 460 [180,800] vs. 200 [80,315], p = 0.002 and 280 [170,420] vs. 95 [55,175], p = 0.004, respectively; PEEP group vs. VT group). The PEEP group showed significantly higher lung compliance and lower driving pressure at T1 and T3. However, there was no significant difference in EELI change, lung compliance, or driving pressure after ARM at T2. Conclusions: The ventilator-driven ARM by the increasing PEEP method led to greater improvements in lung compliance at the end of laparoscopic surgery than the increasing VT method.

Matching positive end-expiratory pressure to intra-abdominal pressure prevents end-expiratory lung volume decline in a pig model of intra-abdominal hypertension*

2012 ◽  
Vol 40 (6) ◽  
pp. 1879-1886 ◽  
Author(s):  
Adrian Regli ◽  
Jakob Chakera ◽  
Bart L. De Keulenaer ◽  
Brigit Roberts ◽  
Bill Noffsinger ◽  
...  
Keyword(s):  
Lung Volume ◽  
Pig Model ◽  
Abdominal Pressure ◽  
Positive End Expiratory Pressure ◽  
Abdominal Hypertension

scholarly journals Manipulating positive end expiratory pressure to recruit lung volume in mechanically ventilated children

2014 ◽  
Vol 27 (1) ◽  
pp. 62
Author(s):  
J. Jauncey-Cooke ◽  
F. Bogossian ◽  
C. East ◽  
T. Pham ◽  
C. Grant ◽  
...  
Keyword(s):  
Lung Volume ◽  
Positive End Expiratory Pressure ◽  
Mechanically Ventilated

scholarly journals Changes in dynamic lung mechanics after lung volume reduction coil treatment of severe emphysema

Thorax ◽  
2017 ◽  
Vol 73 (6) ◽  
pp. 584-586 ◽  
Author(s):  
Demosthenes Makris ◽  
Sylvie Leroy ◽  
Johana Pradelli ◽  
Jonathan Benzaquen ◽  
Hervé Guenard ◽  
...  
Keyword(s):  
Lung Volume ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Dynamic Hyperinflation ◽  
Positive End Expiratory Pressure ◽  
Lung Volume Reduction ◽  
Inspiratory Capacity ◽  
Endurance Time ◽  
Significant Attenuation ◽  
Dynamic Lung Compliance

We assessed the relationships between changes in lung compliance, lung volumes and dynamic hyperinflation in patients with emphysema who underwent bronchoscopic treatment with nitinol coils (coil treatment) (n=11) or received usual care (UC) (n=11). Compared with UC, coil treatment resulted in decreased dynamic lung compliance (CLdyn) (p=0.03) and increased endurance time (p=0.010). The change in CLdyn was associated with significant improvement in FEV1 and FVC, with reduction in residual volume and intrinsic positive end-expiratory pressure, and with increased inspiratory capacity at rest/and at exercise. The increase in end-expiratory lung volume (EELV) during exercise (EELVdyn-ch=EELVisotime EELVrest) demonstrated significant attenuation after coil treatment (p=0.02).

Effects of Recruitment Maneuver and Positive End-Expiratory Pressure on Respiratory Mechanics and Transpulmonary Pressure During Laparoscopic Surgery

2013 ◽  
Vol 57 (6) ◽  
pp. 282-283
Author(s):  
Gilda Cinnella ◽  
Salvatore Grasso ◽  
Savino Spadaro ◽  
Michela Rauseo ◽  
Lucia Mirabella ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Respiratory Mechanics ◽  
Recruitment Maneuver ◽  
Transpulmonary Pressure ◽  
Positive End Expiratory Pressure
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