Effects of Recruitment Maneuver and Positive End-expiratory Pressure on Respiratory Mechanics and Transpulmonary Pressure during Laparoscopic Surgery

• DOI: 10.1097/aln.0b013e3182746a10
• Publication Date: 2012-11-29T09:10:36Z
• Authors: Gilda Cinnella; Salvatore Grasso; Savino Spadaro; Michela Rauseo; Lucia Mirabella; Potito Salatto; Antonella De Capr...; Luigi Nappi; Pantaleo Greco; Michele Dambrosio
• Keywords: Transpulmonary pressure; Positive End-Expiratory Pressure; Respiratory physiology; Plateau pressure; Peak inspiratory pressure

The authors tested the hypothesis that during laparoscopic surgery, Trendelenburg position and pneumoperitoneum may worsen chest wall elastance, concomitantly decreasing transpulmonary pressure, a protective ventilator strategy applied after induction, by increasing would result in alveolar recruitment improvement respiratory mechanics gas exchange.In 29 consecutive patients, recruiting maneuver followed positive end-expiratory pressure 5 cm H(2)O maintained until end of surgery was induction. Respiratory mechanics, exchange, blood cardiac index were measured before (T(BSL)) with zero (T(preOLS)), (T(postOLS)), peritoneum desufflation (T(end)).Esophageal used for partitioning between lung (data are mean ± SD): on T(preOLS), elastance (E(cw)) (E(L)) increased (8.2 0.9 vs. 6.2 1.2 H(2)O/L, respectively, T(BSL); P = 0.00016; 11.69 1.68 9.61 1.52 H(2)O/L 0.0007). On T(postOLS), both E(L) decreased (5.2 8.62 1.03 respectively; 0.00015 T(preOLS)), Pao(2)/inspiratory oxygen fraction improved (491 107 425 97 T(preOLS); 0.008) remaining stable thereafter. Recruited volume (the difference same static airway pressure) 194 80 ml. Pplat(RS) remained while inspiratory (11.65 + 1.37 9.21 2.03 0.007). All parameters abdominal desufflation. Hemodynamic throughout study.In patients submitted to position, an open induction led E(cw) exchange.