Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy

• Published in: Surgical laparoscopy, endoscopy & percutaneous techniques Vol. 24; no. 3; p. 232
• Main Authors: Kundra, Pankaj, Subramani, Yamini, Ravishankar, M, Sistla, Sarath C, Nagappa, Mahesh, Sivashanmugam, T
• Format: Journal Article
• Language: English
• Published: United States 01.06.2014
• Subjects: Abdominal Cavity - physiopathology; Adolescent; Adult; Blood Gas Analysis; Cholecystectomy, Laparoscopic; Female; Follow-Up Studies; Gallbladder Diseases - physiopathology; Gallbladder Diseases - surgery; Hemodynamics - physiology; Humans; Male; Middle Aged; Monitoring, Intraoperative - methods; Pneumoperitoneum, Artificial - methods; Positive-Pressure Respiration - methods; Pressure; Prospective Studies; Pulmonary Gas Exchange - physiology; Single-Blind Method; Young Adult
• ISSN: 1534-4908
• DOI: 10.1097/SLE.0b013e3182a50e77

Applying appropriate positive end-expiratory pressure (PEEP) to corresponding intra-abdominal pressure (IAP) can improve gas exchange during capnoperitoneum without any hemodynamic effects. A total of 75 patients were randomly allocated to group 0PEEP (n=25), group 5PEEP (n=25), and group 10PEEP (n=25) according to the level of PEEP, in whom capnoperitoneum was created with IAP of 14, 8, and 14 mm Hg, respectively. Hemodynamic and respiratory parameters were recorded up to 30 minutes after capnoperitoneum. In 0PEEP group, mean end-tidal carbon dioxide demonstrated significant rise 2 minutes after capnoperitoneum and plateaued at about 15 minutes but remained at high level for up to 30 minutes when compared with the 5PEEP and 10PEEP groups (P<0.05). Correspondingly, the mean PaCO2 (48.0±4.1 mm Hg) for the 0PEEP group was higher at 30 minutes when compared with 5PEEP (37.8±2.7 mm Hg) and 10PEEP (37.2±3.9 mm Hg) groups. The oxygenation was better preserved in 5PEEP and 10PEEP groups with significantly higher PaO2/Fio2 ratio. Heart rate, mean arterial pressure, and cardiac output remained stable throughout the study in all the 3 groups. Application of appropriate PEEP corresponding to the IAP helped maintain CO2 elimination and improved oxygenation without any hemodynamic disturbance in patients undergoing laparoscopic cholecystectomy.