Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of the Effects of Positive End-Expiratory Pressure and Recruitment Manoeuvre Applied in Laparoscopic Surgeries on Respiratory Mechanics and Arterial Oxygenation: Randomized Clinical Trial
Laparoskopik Ameliyatlarda Uygulanan Pozitif Ekspirasyon Sonu Basıncı ve Recruitment Manevrasının Solunum Mekanikleri ve Arteriyel Oksijenizasyon Üzerine Etkilerinin Karşılaştırılması: Randomize Klinik Çalışma
Öznur DEMİROLUK a, Yalım DİKMEN b, İsmail Şener DEMİROLUK c, Ziya SALİHOĞLUb
aDepartment of Anesthesiology and Reanimation, University of Health Sciences Fatih Sultan Mehmet Health Research and Application Center, İstanbul, TURKEY
bDepartment of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, TURKEY
cClinic of Anesthesiology and Reanimation, Medicana International Hospital, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(4):353-61
doi: 10.5336/medsci.2021-84276
Article Language: EN
Full Text
ABSTRACT
 Objective: In patients undergoing mechanical ventilation in laparoscopic surgeries, pulmonary gas exchange and oxygenation are impaired due to many reasons, especially atelectasis. In this study, it was aimed to compare the effects of positive end-expiratory pressure (PEEP) and recruitment practices on respiratory mechanics and oxygenation in patients undergoing laparoscopic surgery. Material and Methods: This prospective study was performed with 60 American Society of Anesthesiologists I-II patients who underwent laparoscopic cholecystectomy. After induction of anaesthesia, the patients were randomly divided into three groups as the patients who were applied +10 cmH2O PEEP during pneumoperitoneum (Group P), patients who were applied 40 cmH2O continuous positive airway pressure (Group S) after desufflation and the control group (Group C). Arterial blood gas values before anesthesia, before insufflation, after insufflation, desufflation and postoperative, respiratory mechanics values during operation [dynamic lung compliance (Cdyn), airway resistance, peak and mean airway pressure] were compared with the relevant time data. Results: While there was a significant decrease in PaO2 in Group C in the post-desufflation period compared to the pre-insufflation period, an increase in PaO2 was observed in both the groups wherein the manoeuvre was applied, especially in Group S. The increase in Group S was significantly higher than Group P. In all postoperative periods, arterial oxygenation values were significantly higher in groups wherein manoeuvre was applied (Group P: p=0.006, p<0.001, p<0.001; Group S: p=0.042, p<0.001, p=0.004). Dynamic compliance values decreased in all groups after insufflation. During the desufflation period, Cdyn values were significantly higher in Group P and especially in Group S compared to Group C (p<0.001). Conclusion: Recruitment manoeuvres are effective and safe in preventing impairment of blood gas and respiratory mechanics in patients undergoing laparoscopic surgery.

Keywords: Anaesthesia, general; laparoscopic surgery; positive-pressure respiration; pulmonary atelectasis; respiratory mechanics
ÖZET
 Amaç: Laparoskopik ameliyatlarda mekanik ventilasyon uygulanan hastalarda pulmoner gaz değişimi ve oksijenasyon başta atelektazi olmak üzere birçok nedenden dolayı bozulmaktadır. Bu çalışmada, laparoskopik cerrahi geçiren hastalarda pozitif ekspirasyon sonu basıncı [positive end-expiratory pressure (PEEP)] ve recruitment uygulamalarının solunum mekaniği ve oksijenasyon üzerine etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Bu prospektif çalışma, laparoskopik kolesistektomi uygulanan 60 Amerikan Anestezistler Derneği I-II hasta ile gerçekleştirildi. Anestezi indüksiyonu sonrası hastalar pnömoperiton sırasında +10 cmH2O PEEP (Grup P), desüflasyon sonrası 40 cmH2O sürekli pozitif hava yolu basıncı uygulanan hastalar (Grup S) ve kontrol grubu (Grup C) olarak randomize gruplara ayrıldı. Anestezi öncesi, insüflasyon öncesi, insüflasyon sonrası, desüflasyon ve postoperatif arteriyel kan gazı değerleri, operasyon sırasındaki solunum mekanik değerleri [dinamik akciğer kompliyansı (Cdyn), hava yolu direnci, tepe ve ortalama hava yolu basıncı] ilgili zaman verileri ile karşılaştırıldı. Bulgular: Grup C'de PaO2'de desüflasyon sonrası dönemde, insüflasyon öncesi döneme göre anlamlı bir düşüş olurken, manevranın uygulandığı her 2 grupta özellikle de Grup S'de PaO2'de artış gözlendi. Grup S'deki artış, Grup P'den anlamlı derecede yüksekti. Tüm postoperatif dönemlerde manevra uygulanan gruplarda arteriyel oksijenasyon değerleri anlamlı olarak yüksekti (Grup P: p=0,006, p<0,001, p<0,001; Grup S: p=0,042, p<0,001, p=0,004). İnsüflasyon sonrası tüm gruplarda Cdyn değerleri azaldı. Desüflasyon döneminde Cdyn değerleri Grup P'de ve özellikle Grup S'de Grup C'ye göre anlamlı olarak yüksekti (p<0,001). Sonuç: Recruitment manevraları, laparoskopik cerrahi geçiren hastalarda kan gazı ve solunum mekaniğinin bozulmasını önlemede etkili ve güvenlidir.

Anahtar Kelimeler: Anestezi, genel; laparoskopik cerrahi; pozitif basınçlı solunum; pulmoner atelektazi; solunum mekaniğ
REFERENCES:
  1. Hedenstierna G, Rothen HU. Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput. 2000;16(5-6):329-35. [PubMed] 
  2. Hedenstierna G, Edmark L. Mechanisms of atelectasis in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010;24(2):157-69. [Crossref]  [PubMed] 
  3. Choi ES, Oh AY, In CB, Ryu JH, Jeon YT, Kim HG. Effects of recruitment manoeuvre on perioperative pulmonary complications in patients undergoing robotic assisted radical prostatectomy: A randomised single-blinded trial. PLoS One. 2017;12(9):e0183311. [Crossref]  [PubMed]  [PMC] 
  4. Nguyen TK, Nguyen VL, Nguyen TG, Mai DH, Nguyen NQ, Vu TA, et al. Lung-protective mechanical ventilation for patients undergoing abdominal laparoscopic surgeries: a randomized controlled trial. BMC Anesthesiol. 2021;21(1):95. [Crossref]  [PubMed]  [PMC] 
  5. Martínez G, Cruz P. Atelectasias en anestesia general y estrategias de reclutamiento alveolar [Atelectasis in general anesthesia and alveolar recruitment strategies]. Rev Esp Anestesiol Reanim. 2008;55(8):493-503. [Crossref]  [PubMed] 
  6. Edward MG, Jr. Maged SM. Anesthesia for patients with respiratory disease. Clinical Anesthesiology. 3rd ed. Chapter 23. USA: McGraw-Hill Companies; 2002. p.511-24.
  7. Kim BR, Lee S, Bae H, Lee M, Bahk JH, Yoon S. Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol. 2020;20(1):173. [Crossref]  [PubMed]  [PMC] 
  8. Demiroluk S, Salihoglu Z, Bakan M, Bozkurt P. Effects of intraperitoneal and extraperitoneal carbon dioxide insufflation on blood gases during the perioperative period. J Laparoendosc Adv Surg Tech A. 2004;14(4):219-22. [Crossref]  [PubMed] 
  9. Joris JL. Anesthesia for laparoscopic surgery. In: Miller RD, ed. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000. p.2003-23.
  10. Tusman G, Böhm SH. Prevention and reversal of lung collapse during the intra-operative period. Best Pract Res Clin Anaesthesiol. 2010;24(2):183-97. [Crossref]  [PubMed] 
  11. Hartland BL, Newell TJ, Damico N. Alveolar recruitment maneuvers under general anesthesia: a systematic review of the literature. Respir Care. 2015;60(4):609-20. [Crossref]  [PubMed] 
  12. Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth. 1993;71(6):788-95. [Crossref]  [PubMed] 
  13. Rothen HU, Neumann P, Berglund JE, Valtysson J, Magnusson A, Hedenstierna G. Dynamics of re-expansion of atelectasis during general anaesthesia. Br J Anaesth. 1999;82(4):551-6. [Crossref]  [PubMed] 
  14. Kim JY, Shin CS, Kim HS, Jung WS, Kwak HJ. Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc. 2010;24(5):1099-103. [Crossref]  [PubMed] 
  15. Claxton BA, Morgan P, McKeague H, Mulpur A, Berridge J. Alveolar recruitment strategy improves arterial oxygenation after cardiopulmonary bypass. Anaesthesia. 2003;58(2):111-6. [Crossref]  [PubMed] 
  16. Arora V, Tyagi A, Kumar S, Kakkar A, Das S. Intraoperative low tidal volume ventilation strategy has no benefits during laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2017;33(1):57-63. [Crossref]  [PubMed]  [PMC] 
  17. Futier E, Constantin JM, Pelosi P, Chanques G, Kwiatkoskwi F, Jaber S, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiology. 2010;113(6):1310-9. [Crossref]  [PubMed] 
  18. Maracajá-Neto LF, Verçosa N, Roncally AC, Giannella A, Bozza FA, Lessa MA. Beneficial effects of high positive end-expiratory pressure in lung respiratory mechanics during laparoscopic surgery. Acta Anaesthesiol Scand. 2009;53(2):210-7. [Crossref]  [PubMed] 
  19. Weingarten TN, Whalen FX, Warner DO, Gajic O, Schears GJ, Snyder MR, et al. Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery. Br J Anaesth. 2010;104(1):16-22. [Crossref]  [PubMed] 
  20. Longo MA, Cavalheiro BT, de Oliveira Filho GR. Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses. J Clin Anesth. 2017;41:48-54. [Crossref]  [PubMed] 
  21. Iwasaka H, Miyakawa H, Yamamoto H, Kitano T, Taniguchi K, Honda N. Respiratory mechanics and arterial blood gases during and after laparoscopic cholecystectomy. Can J Anaesth. 1996;43(2):129-33. [Crossref]  [PubMed] 
  22. Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc. 2016;30(10):4598-606. [Crossref]  [PubMed] 

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