scholarly journals The Effect of Ventilation with Individualized Positive End-Expiratory Pressure on Postoperative Atelectasis in Patients Undergoing Robot-Assisted Radical Prostatectomy: A Randomized Controlled Trial

2021 ◽  
Vol 10 (4) ◽  
pp. 850
Author(s):  
Hyun-Kyu Yoon ◽  
Bo Rim Kim ◽  
Susie Yoon ◽  
Young Hyun Jeong ◽  
Ja Hyeon Ku ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Lung Ultrasound ◽  
Positive End Expiratory Pressure ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Respiratory Compliance ◽  
Steep Trendelenburg Position ◽  
Ultrasound Score ◽  
The Difference ◽  
Postoperative Atelectasis

For patients undergoing robot-assisted radical prostatectomy, the pneumoperitoneum with a steep Trendelenburg position could worsen intraoperative respiratory mechanics and result in postoperative atelectasis. We investigated the effects of individualized positive end-expiratory pressure (PEEP) on postoperative atelectasis, evaluated using lung ultrasonography. Sixty patients undergoing robot-assisted radical prostatectomy were randomly allocated into two groups. Individualized groups (n = 30) received individualized PEEP determined by a decremental PEEP trial using 20 to 7 cm H2O, aiming at maximizing respiratory compliance, whereas standardized groups (n = 30) received a standardized PEEP of 7 cm H2O during the pneumoperitoneum. Ultrasound examination was performed on 12 sections of thorax, and the lung ultrasound score was measured as 0–3 by considering the number of B lines and the degree of subpleural consolidation. The primary outcome was the difference between the lung ultrasound scores measured before anesthesia induction and just after extubation in the operating room. An increase in the difference means the development of atelectasis. The optimal PEEP in the individualized group was determined as the median (interquartile range) 14 (12–18) cm H2O. Compared with the standardized group, the difference in the lung ultrasound scores was significantly smaller in the individualized group (−0.5 ± 2.7 vs. 6.0 ± 2.9, mean difference −6.53, 95% confidence interval (−8.00 to −5.07), p < 0.001), which means that individualized PEEP was effective to reduce atelectasis. The lung ultrasound score measured after surgery was significantly lower in the individualized group than the standardized group (8.1 ± 5.7 vs. 12.2 ± 4.2, mean difference −4.13, 95% confidence interval (−6.74 to −1.53), p = 0.002). However, the arterial partial pressure of the oxygen/fraction of inspired oxygen levels during the surgery showed no significant time-group interaction between the two groups in repeated-measures analysis of variance (p = 0.145). The incidence of a composite of postoperative respiratory complications was comparable between the two groups. Individualized PEEP determined by maximal respiratory compliance during the pneumoperitoneum and steep Trendelenburg position significantly reduced postoperative atelectasis, as evaluated using lung ultrasonography. However, the clinical significance of this finding should be evaluated by a larger clinical trial.

scholarly journals Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review

2020 ◽  
pp. 75-89
Author(s):  
Ildar I. Lutfarakhmanov ◽  
I. A Melnikova ◽  
E. Yu Syrchin ◽  
V. F Asadullin ◽  
Yu. A Korelov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Gas Exchange ◽  
The Body ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Positive End Expiratory Pressure ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Steep Trendelenburg Position

Introduction. Prostate cancer remains the most common urological malignancy, and robot-assisted radical prostatectomy (RARP) is the most effective treatment option. Special conditions for operation (Trendelenburg position and pneumoperitoneum) increase the airway pressure and reduce functional residual capacity of the lungs. Objectives. Review of risk factors for disorders and various interventions to improve pulmonary function and reduce the adverse physiological effects of RARP under general anesthesia. Materials and methods. This review of literature was conducted using the PubMed search engine in electronic databases Medline, Embase, the Cochrane Library and others up to May 2019. Results. A total of 22 studies were searched, including 9 randomized controlled trials. The factor that could worsen gas exchange during RARP was the body mass index 30 kg/m2. It is possible to improve gas exchange by means of recruitment maneuvers. Positive end-expiratory pressure of 5-10 cm H2O improves oxygenation but requires alertness in patients with chronic heart failure and chronic obstructive pulmonary disease. Conclusions. The main risk factors for perioperative respiratory and oxygenation disorders in RARP are pneumoperitoneum and steep Trendelenburg position. The effectiveness of ventilation regimes for the prevention of gas exchange disorders has not been proven. Using the recruitment maneuver and increasing the positive end-expiratory pressure does not improve the respiratory function of the lungs. Further studies with a longer follow-up period are needed to determine the clinical efficacy and safety of RARP.

scholarly journals Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position

2020 ◽  
Vol 132 (3) ◽  
pp. 476-490 ◽  
Author(s):  
Atsuko Shono ◽  
Nozomi Katayama ◽  
Tatsuya Fujihara ◽  
Stephan H. Böhm ◽  
Andreas D. Waldmann ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Mechanics ◽  
High Peep ◽  
Positive End Expiratory Pressure ◽  
Regional Ventilation ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Steep Trendelenburg Position ◽  
Postoperative Lung Function

Abstract Background Pneumoperitoneum and a steep Trendelenburg position during robot-assisted laparoscopic prostatectomy have been demonstrated to promote a cranial shift of the diaphragm and the formation of atelectasis in the dorsal parts of the lungs. However, neither an impact of higher positive end-expiratory pressure (PEEP) on preserving the ventilation in the dorsal region nor its physiologic effects have been fully examined. The authors hypothesized that PEEP of 15 cm H2O during robot-assisted laparoscopic prostatectomy might maintain ventilation in the dorsal parts and thus improve lung mechanics. Methods In this randomized controlled study, 48 patients undergoing robot-assisted laparoscopic prostatectomy were included in the analysis. Patients were assigned to the conventional PEEP (5 cm H2O) group or the high PEEP (15 cm H2O) group. Regional ventilation was monitored using electrical impedance tomography before and after the establishment of pneumoperitoneum and 20° Trendelenburg position during the surgery. The primary endpoint was the regional ventilation in the dorsal parts of the lungs while the secondary endpoints were lung mechanics and postoperative lung function. Results Compared to that in the conventional PEEP group, the fraction of regional ventilation in the most dorsal region was significantly higher in the high PEEP group during pneumoperitoneum and Trendelenburg position (mean values at 20 min after taking Trendelenburg position: conventional PEEP, 5.5 ± 3.9%; high PEEP, 9.9 ± 4.7%; difference, –4.5%; 95% CI, –7.4 to –1.6%; P = 0.004). Concurrently, lower driving pressure (conventional PEEP, 14.9 ± 2.5 cm H2O; high PEEP, 11.5 ± 2.8 cm H2O; P &lt; 0.001), higher lung dynamic compliance, and better oxygenation were demonstrated in the high PEEP group. Postoperative lung function did not differ between the groups. Conclusions Application of a PEEP of 15 cm H2O resulted in more homogeneous ventilation and favorable physiologic effects during robot-assisted laparoscopic prostatectomy but did not improve postoperative lung function. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

2020 ◽  
Author(s):  
Bo Rim Kim ◽  
Seohee Lee ◽  
Hansu Bae ◽  
Minkyoo Lee ◽  
Jae-Hyon Bahk ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Lung Ultrasound ◽  
Controlled Trial ◽  
Pulmonary Complications ◽  
Alveolar Recruitment ◽  
Postoperative Pulmonary Complications ◽  
Trendelenburg Position ◽  
Alveolar Recruitment Maneuver ◽  
Ultrasound Score ◽  
Inspired Oxygen

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio 2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio 2 0.4; n=44) and high-Fio 2 (Fio 2 1.0, n=46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio 2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao 2 to Fio 2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM ( P =0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio 2 group (7.0±4.1 vs 11.7±4.2, mean difference 4.7, 95% CI 2.96–6.44, P <0.001). Significant atelectasis postoperatively was more common in the high-Fio 2 group (relative risk 1.77, 95% CI 1.27‒2.47, P <0.001). Intra- and postoperative Pao 2 to Fio 2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio 2 . High-Fio 2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio 2 . No oxygenation benefit was observed in the high-Fio 2 group.

Hemodynamic Perturbations During Robot-Assisted Laparoscopic Radical Prostatectomy in 45° Trendelenburg Position

2011 ◽  
Vol 113 (5) ◽  
pp. 1069-1075 ◽  
Author(s):  
Melinda Lestar ◽  
Lars Gunnarsson ◽  
Lars Lagerstrand ◽  
Peter Wiklund ◽  
Suzanne Odeberg-Wernerman
Keyword(s):  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
Trendelenburg Position
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