Publication: Intraabdominal pressure targeted positive end-expiratory pressure during laparoscopic surgery: An open-label, nonrandomized, crossover, clinical trial
Issued Date
2020-01-01
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ISSN
15281175
00033022
00033022
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2-s2.0-85082146627
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Mahidol University
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SCOPUS
Bibliographic Citation
Anesthesiology. (2020), 667-677
Suggested Citation
Guido Mazzinari, Oscar Diaz-Cambronero, Jose Miguel Alonso-Iñigo, Nuria Garcia-Gregorio, Begoña Ayas-Montero, Jose Luis Ibañez, Ary Serpa Neto, Lorenzo Ball, Marcelo Gama De Abreu, Paolo Pelosi, Javier Maupoey, Maria Pilar Argente Navarro, Marcus J. Schultz Intraabdominal pressure targeted positive end-expiratory pressure during laparoscopic surgery: An open-label, nonrandomized, crossover, clinical trial. Anesthesiology. (2020), 667-677. doi:10.1097/ALN.0000000000003146 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/54691
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Title
Intraabdominal pressure targeted positive end-expiratory pressure during laparoscopic surgery: An open-label, nonrandomized, crossover, clinical trial
Other Contributor(s)
Ospedale Policlinico San Martino
Hospital Universitari i Politècnic La Fe
Università degli Studi di Genova
Instituto do Coracao do Hospital das Clinicas
Technische Universität Dresden
Hospital Israelita Albert Einstein
Mahidol University
Nuffield Department of Clinical Medicine
Amsterdam UMC - University of Amsterdam
Hospital Universitari i Politècnic La Fe
Università degli Studi di Genova
Instituto do Coracao do Hospital das Clinicas
Technische Universität Dresden
Hospital Israelita Albert Einstein
Mahidol University
Nuffield Department of Clinical Medicine
Amsterdam UMC - University of Amsterdam
Abstract
Copyright © 2020, the American Society of Anesthesiologists, Inc. All Rights Reserved. Background: Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumo-peritoneum-related rises in driving pressure. Methods: Open-label, nonrandomized, crossover, clinical trial in patients undergoing laparoscopic cholecystectomy. "Targeted PEEP" (2 cm H2O above intraabdominal pressure) was compared with "standard PEEP" (5 cm H2O), with respect to the transpulmonary and respiratory system driving pressure at three predefined intraabdominal pressure levels, and each patient was ventilated with two levels of PEEP at the three intraabdominal pressure levels in the same sequence. The primary outcome was the difference in transpulmonary driving pressure between targeted PEEP and standard PEEP at the three levels of intraabdominal pressure. results: Thirty patients were included and analyzed. Targeted PEEP was 10, 14, and 17 cm H2O at intraabdominal pressure of 8, 12, and 15 mmHg, respectively. Compared to standard PEEP, targeted PEEP resulted in lower median transpulmonary driving pressure at intraabdominal pressure of 8 mmHg (7 [5 to 8] vs. 9 [7 to 11] cm H2O; P = 0.010; difference 2 [95% CI 0.5 to 4 cm H2O]); 12 mmHg (7 [4 to 9] vs.10 [7 to 12] cm H2O; P = 0.002; difference 3 [1 to 5] cm H2O); and 15 mmHg (7 [6 to 9] vs.12 [8 to 15] cm H2O; P < 0.001; difference 4 [2 to 6] cm H2O). The effects of targeted PEEP compared to standard PEEP on respiratory system driving pressure were comparable to the effects on transpulmonary driving pressure, though respiratory system driving pressure was higher than transpulmonary driving pressure at all intraabdominal pressure levels. conclusions: Transpulmonary driving pressure rises with an increase in intraabdominal pressure, an effect that can be counterbalanced by targeted PEEP. Future studies have to elucidate which combination of PEEP and intraabdominal pressure is best in term of clinical outcomes.