Recruitment-to-inflation ratio to assess response to PEEP during laparoscopic surgery: A physiologic study

• DOI: 10.1016/j.jclinane.2024.111569
• Publication Date: 2024-08-05T20:35:47Z
• Authors: Marco Covotta; Claudia Claroni; Giulia Torregiani; Luca S. Menga; Emanuela Venti; Gaetano Gazzè; Gian Marco Anzell...; Valentina Ceccarelli; Pierpaolo Gaglioti; Sara Orlando; Tommaso Rosà; Ester Forastiere; Massimo Antonelli; Domenico L. Grieco
• Keywords: Positive End-Expiratory Pressure; Respiratory physiology

During laparoscopic surgery, the role of PEEP to improve outcome is controversial. Mechanistically, benefits depend on extent alveolar recruitment, which prevents ventilator-induced lung injury by reducing dynamic strain. The hypotheses this study were that pneumoperitoneum-induced aeration loss and PEEP-induced recruitment are inter-individually variable, recruitment-to-inflation ratio (R/I) can identify patients who benefit from in terms strain reduction. Sequential study. Operating room. Seventeen ASA I-III receiving robot-assisted prostatectomy during Trendelenburg pneumoperitoneum. Patients underwent end-expiratory volume (EELV) respiratory/lung/chest wall mechanics (esophageal manometry inspiratory/expiratory occlusions) assessment at = 0 cmH2O before after pneumoperitoneum, 4 12 Pneumoperitoneum-induced derecruitment assessed through a simplified method based multiple pressure-volume curve. Dynamic static changes evaluated. R/I between was EELV. Inter-individual variability rated with standard deviation mean (CoV). Pneumoperitoneum reduced EELV (median [IqR]) 410 mL [80–770] (p < 0.001) increased 0.04 [0.01–0.07] 0.001), high inter-individual (CoV 70% 88%, respectively). Compared cmH2O, yielded variable amount (139 [96–366] CoV 101%), causing different reduction decrease 0.02 [0.01–0.04], p 0.002; 86%) increases increase 0.05 [0.04–0.07], 0.01, 33%). (1.73 [0.58–3.35]) estimated ≤0.001, r −0.90) 0.009, −0.73) induced PEEP, while respiratory did not. pneumoperitoneum yields derecruitment: capability revert these phenomena varies significantly among individuals. High identifies whom higher mostly reduces limited increases, potentially allowing individualized settings.