Publication: Modeling intra-abdominal volume and respiratory driving pressure during pneumoperitoneum insufflation — A patient-level data meta-analysis
Issued Date
2021-03-01
Resource Type
ISSN
15221601
87507587
87507587
Other identifier(s)
2-s2.0-85103226808
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Applied Physiology. Vol.130, No.3 (2021), 721-728
Suggested Citation
Guido Mazzinari, Oscar Diaz-Cambronero, Ary Serpa Neto, Antonio Cañada Martínez, Lucas Rovira, María Pilar Argente Navarro, Manu L.N.G. Malbrain, Paolo Pelosi, Marcelo Gama De Abreu, Markus W. Hollmann, Marcus J. Schultz Modeling intra-abdominal volume and respiratory driving pressure during pneumoperitoneum insufflation — A patient-level data meta-analysis. Journal of Applied Physiology. Vol.130, No.3 (2021), 721-728. doi:10.1152/JAPPLPHYSIOL.00814.2020 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/76258
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Title
Modeling intra-abdominal volume and respiratory driving pressure during pneumoperitoneum insufflation — A patient-level data meta-analysis
Other Contributor(s)
Faculteit Geneeskunde en Farmacie
IRCCS San Martino Polyclinic Hospital
Instituto de Investigación Sanitaria La Fe
Universitair Ziekenhuis Brussel
Hospital Universitari i Politècnic La Fe
Università degli Studi di Genova
Technische Universität Dresden
Hospital Israelita Albert Einstein
Hospital General Universitario de Valencia
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC - University of Amsterdam
International Fluid Academy
Spanish Clinical Research Network (SCReN)
Outcomes Research Consortium
IRCCS San Martino Polyclinic Hospital
Instituto de Investigación Sanitaria La Fe
Universitair Ziekenhuis Brussel
Hospital Universitari i Politècnic La Fe
Università degli Studi di Genova
Technische Universität Dresden
Hospital Israelita Albert Einstein
Hospital General Universitario de Valencia
Mahidol University
Nuffield Department of Medicine
Universidade de São Paulo
Amsterdam UMC - University of Amsterdam
International Fluid Academy
Spanish Clinical Research Network (SCReN)
Outcomes Research Consortium
Abstract
During pneumoperitoneum, intra-abdominal pressure (IAP) is usually kept at 12–14 mmHg. There is no clinical benefit in IAP increments if they do not increase intra-abdominal volume IAV. We aimed to estimate IAV (DIAV) and respiratory driving pressure changes (DPRS) in relation to changes in IAP (DIAP). We carried out a patient-level meta-analysis of 204 adult patients with available data on IAV and DPRS during pneumoperitoneum from three trials assessing the effect of IAP on postoperative recovery and airway pressure during laparoscopic surgery under general anesthesia. The primary endpoint was DIAV, and the secondary endpoint was DPRS. The endpoints’ response to DIAP was modeled using mixed multivariable Bayesian regression to estimate which mathematical function best fitted it. IAP values on the pressure–volume (PV) curve where the endpoint rate of change according to IAP decreased were identified. Abdomino-thoracic transmission (ATT) rate, that is, the rate DPRS change to DIAP was also estimated. The best-fitting function was sigmoid logistic and linear for IAV and DPRS response, respectively. Increments in IAV reached a plateau at 6.0 [95%CI 5.9–6.2] L. DIAV for each DIAP decreased at IAP ranging from 9.8 [95%CI 9.7–9.9] to 12.2 [12.0–12.3] mmHg. ATT rate was 0.65 [95%CI 0.62–0.68]. One mmHg of IAP raised DPRS 0.88 cmH2O. During pneumoperitoneum, IAP has a nonlinear relationship with IAV and a linear one with DPRS. IAP should be set below the point where IAV gains diminish. NEW & NOTEWORTHY We found that intra-abdominal volume changes related to intra-abdominal pressure increase reached a plateau with diminishing gains in commonly used pneumoperitoneum pressure ranges. We also found a linear relationship between intra-abdominal pressure and respiratory driving pressure, a known marker of postoperative pulmonary complications.