Guido MazzinariOscar Diaz-CambroneroAry Serpa NetoAntonio Cañada MartínezLucas RoviraMaría Pilar Argente NavarroManu L.N.G. MalbrainPaolo PelosiMarcelo Gama De AbreuMarkus W. HollmannMarcus J. SchultzFaculteit Geneeskunde en FarmacieIRCCS San Martino Polyclinic HospitalInstituto de Investigación Sanitaria La FeUniversitair Ziekenhuis BrusselHospital Universitari i Politècnic La FeUniversità degli Studi di GenovaTechnische Universität DresdenHospital Israelita Albert EinsteinHospital General Universitario de ValenciaMahidol UniversityNuffield Department of MedicineUniversidade de São PauloAmsterdam UMC - University of AmsterdamInternational Fluid AcademySpanish Clinical Research Network (SCReN)Outcomes Research Consortium2022-08-042022-08-042021-03-01Journal of Applied Physiology. Vol.130, No.3 (2021), 721-72815221601875075872-s2.0-85103226808https://repository.li.mahidol.ac.th/handle/123456789/76258During 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.Mahidol UniversityBiochemistry, Genetics and Molecular BiologyMedicineArticleSCOPUS10.1152/JAPPLPHYSIOL.00814.2020