Highlights
- •Intraoperative mechanical ventilation in which the positive end-expiratory pressure (PEEP) level is tailored to the respiratory system's dynamic compliance (Cdyn) after a recruitment maneuver results in favorable lung protective effects.
- •Cdyn-guided PEEP ventilation strategies was sufficient to maintain the normal systolic and diastolic function of the right ventricle and resulted in lower driving pressure.
- •Cdyn-guided PEEP ventilation strategies to fit an individual patient undergoing abdominal laparoscopic surgery in the trendelenburg position is of more vital importance and worth promoting.
Abstract
Background
The intraoperative effects of mechanical ventilation with individualized positive
end-expiratory pressure guided by dynamic compliance on right heart function remains
undefined.
Objectives
To investigate whether individualized ventilation is superior to standard ventilation
in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg
position.
Methods
Forty patients who underwent abdominal laparoscopic surgery were randomly divided
into two groups: Group T (titrimetric positive end-expiratory pressure [PEEP]) and
Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured using transesophageal echocardiography,
which included tricuspid annular plane systolic excursion, early-to-late filing ratio
of the right ventricle, and right ventricular end-diastolic area/left ventricular
end-diastolic area ratio during mechanical ventilation.
Results
No significant difference in the tricuspid annular plane systolic excursion or early-to-late
filling ratio of the right ventricle was noted between the groups during the whole
procedure (P>0.05). We noticed an increase in right ventricular end-diastolic area/left ventricular
end-diastolic area ratio at T0 vs. T2 in Group T (0.53±0.02 vs. 0.60±0.06, respectively; P = 0.0208) and Group I (0.54±0.01 vs. 0.62±0.06, respectively; P = 0.0018).
Conclusions
Intraoperative lung-protective ventilation with dynamic compliance-guided PEEP does
not have obvious side effects on the right heart function when compared with standard
protective ventilation during laparoscopic surgery in the Trendelenburg position.
Keywords
Abbreviations:
ECG (Electrocardiogram), HR (Heart rate), LV (Left ventricular), LVEDA (LV end-diastolic area), PEEP (Positive end-expiratory pressure), PF (Partial pressure of arterial oxygen to inspiratory oxygen fraction), RA (Right atrium), RM (Recruitment maneuver), RV (Right ventricle), RVEDA (RV end-diastolic area), TAPSE (Tricuspid annular plane systolic excursion), TEE (Transesophageal echocardiography), VT (Tidal volume)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 17, 2022
Accepted:
December 9,
2022
Received in revised form:
December 8,
2022
Received:
August 1,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
