Ventilator-driven Alveolar Recruitment Maneuver

Background: Impaired respiratory functions during general anesthesia are commonly caused by lung atelectasis more in morbidly obese patients. This occurs more frequently with laparoscopic surgery due to trendelenburg position and pneumoperitoneum. Preemptive recruitment maneuver + PEEP results in the prevention of these changes. Aim: To quantitate the effects of RM and PEEP on intraoperative hypoxemia and respiratory mechanics during laparoscopic gastric banding in obese patients. Study Design: A randomized, double-blinded, controlled study. Method and Materials: Fifty adults ASA I-II, BMI (40-50 kg/m2) for elective laparoscopic gastric banding were randomized into, groups C, and RM, 25 patients each. Group C patients received standard ventilation, VT 6 ml/kg, I: E ratio 1: 2 PEEP 5 cm H2O, and respiratory rate 10-12 breaths/ min. RM patients received standard ventilation with one alveolar recruitment maneuver after mechanical ventilation with PEEP of 15 cm H2O till the end of the surgery. Heart rate, mean blood pressure, respiratory mechanical parameters: peak airway pressure, plateau pressure and end-expiratory lung volume, PaO2, PaO2/FiO2 and (SpO2) were assessed. Results: PaO2 and PaO2/FiO2 ratio increased significantly in the RM group after RM from T2 (before pneumoperitoneum) to T6 (end of surgery) compared with group C (P < 0.001). Peak and plateau airway pressures increased significantly in group C from T2 till T5 (60 min after pneumoperitoneum) compared with the RM group (P < 0.001). End-expiratory lung volume increased significantly in the RM group after RM compared with group C (P<0.001). Conclusion: Preemptive RM with PEEP of 15 cm H2O was effective in preventing pneumoperitoneum-induced intraoperative hypoxemia and respiratory mechanics changes.

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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

Journal of Clinical Medicine ◽

10.3390/jcm10173921 ◽

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.

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