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

Anesthesiology
Atsuko ShonoYoji Saito

Abstract

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. 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. Compared to that in the conventional PEEP group, the fraction of regional ...Continue Reading

References

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Citations

Sep 10, 2020·Anesthesiology·David LagierMarie-Christine Alessi
Jul 18, 2020·Anesthesiology·Nishant SahayShagufta Naaz
Nov 12, 2020·Minerva anestesiologica·Luciano FrassanitoGaetano Draisci
Nov 3, 2020·British Journal of Anaesthesia·UNKNOWN Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR) Study InvestigatorsUNKNOWN AVATaR Investigators
Apr 13, 2021·Anesthesiology·Philipp SimonUNKNOWN PROBESE Investigators of the Protective Ventilation Network* and the Clinical Trial Network of the European Society of Anest

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