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Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy

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Abstract

Background

During laparoscopy, pneumoperitoneum may result in intraoperative atelectasis, which impairs normal gas exchange. This study investigated whether positive end-expiratory pressure (PEEP) of 5 cmH2O in pressure-controlled ventilation (PCV) mode can improve ventilatory and oxygenation parameters during pneumoperitoneum.

Methods

Thirty patients, aged 18–65 years, undergoing laparoscopic cholecystectomy were randomly allocated to the ZEEP (PEEP = 0 cmH2O) or PEEP (PEEP = 5 cmH2O) group. PCV was started after induction of anesthesia. Apart from PEEP level, all other ventilator settings were identical for both groups. Peak airway pressure was set at induction and reset after pneumoperitoneum to deliver tidal volume of 8 ml/kg in both groups. Hemodynamic, ventilatory, and oxygenation parameters were measured after induction of anesthesia (T1) and 30 min after pneumoperitoneum (T2).

Results

Oxygenation index (PaO2/FiO2) was significantly higher in the PEEP group than in the ZEEP group at T2 (P = 0.031). In both groups, dynamic compliance significantly decreased over 40 min from T1 to T2. There were no significant differences in hemodynamics between the two groups during the study period.

Conclusion

Application of PEEP of 5 cmH2O should be considered in PCV during laparoscopic surgeries to decrease intraoperative atelectasis caused by pneumoperitoneum to improve gas exchange and oxygenation.

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Disclosures

Drs. Ji Young Kim, Cheung Soo Shin, Hong Soon Kim, Wol Sun Jung, and Hyun Jeong Kwak have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

    Ji Young Kim & Cheung Soo Shin

  2. Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea

    Hong Soon Kim, Wol Sun Jung & Hyun Jeong Kwak

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  1. Ji Young Kim
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  2. Cheung Soo Shin
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  3. Hong Soon Kim
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Correspondence to Hyun Jeong Kwak.

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Kim, J.Y., Shin, C.S., Kim, H.S. et al. Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc 24, 1099–1103 (2010). https://doi.org/10.1007/s00464-009-0734-6

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  • DOI: https://doi.org/10.1007/s00464-009-0734-6

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