Exploring the intraoperative lung protective ventilation of different positive end-expiratory pressure levels during abdominal laparoscopic surgery with Trendelenburg position

作者：Yun Wang, Hong Wang, Huijuan Wang, Xiao Zhao, Shitong Li, Lianhua Chen · 发表于：Annals of Translational Medicine · 年份：2019 · DOI：10.21037/atm.2019.03.45 · 被引用次数：19 · 研究领域：Respiratory Support and Mechanisms、Abdominal Surgery and Complications、Hemodynamic Monitoring and Therapy

Background: The intraoperative lung protective effect of mechanical ventilation of different positive end-expiratory pressure (PEEP) levels on patients undergoing abdominal laparoscopic surgery with the steep Trendelenburg position remains undefined. The purpose of the study was to explore the optimal PEEP. Methods: Sixty patients scheduled for abdominal laparoscopic surgery were randomized to four groups including: PEEP 0, 4, 8 and 12 cmH 2 O. The pulmonary dynamic compliance (Cdyn), dead space to tidal volume ratio (VD/VT), and intrapulmonary shunt ratio (QS/QT) were measured after anesthesia induction (T 0 ), 5 min after pneumoperitoneum (PNP) with position change (T 1 ), 30 (T 2 ) and 60 min (T 3 ) after PEEP, and end of surgery (T 4 ). Results: Cdyn increased when different levels of PEEP (including the 4, 8, and 12 cmH 2 O) were used vs . no PEEP (P<0.05). The VD/VT in PEEP 8 and 12 cmH 2 O were significantly improved than no PEEP (P<0.05). Meanwhile, the QS/QT in PEEP 12 cmH 2 O was higher than others during the procedures. Conclusions: A moderate PEEP level (8 cmH 2 O) with low tidal volume was sufficient to improve Cdyn and to decrease VD/VT without increasing QS/QT, which was suggested to be a good choice of intraoperative lung protective ventilation during abdominal laparoscopic surgery with Trendelenburg position.