- •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.
The intraoperative effects of mechanical ventilation with individualized positive end-expiratory pressure guided by dynamic compliance on right heart function remains undefined.
To investigate whether individualized ventilation is superior to standard ventilation in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg position.
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.
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).
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.
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)
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- Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation.Anesth Analg. 2014; 118: 657-665https://doi.org/10.1213/ANE.0000000000000105
- Open lung approach versus standard protective strategies: effects on driving pressure and ventilatory efficiency during anesthesia – A pilot, randomized controlled trial.PLoS ONE. 2017; 12e0177399https://doi.org/10.1371/journal.pone.0177399
- Influence of positive end-expiratory pressure on left ventricular performance.N Engl J Med. 1981; 304: 387-392https://doi.org/10.1056/NEJM198102123040703
- Schultz MJHigh versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial.Lancet. 2014; 384: 495-503https://doi.org/10.1016/S0140-6736(14)60416-5
- Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery.Anesthesiology. 2002; 97: 820-826https://doi.org/10.1097/00000542-200210000-00012
- Standardizing predicted body weight equations for mechanical ventilation tidal volume settings.Chest. 2015; 148: 73-78https://doi.org/10.1378/chest.14-2843
- Driving pressure and survival in the acute respiratory distress syndrome.N Engl J Med. 2015; 372: 747-755https://doi.org/10.1056/NEJMsa1410639
- Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.Lancet Respir Med. 2018; 6: 193-203https://doi.org/10.1016/S2213-2600(18)30024-9
- Myocardial performance index (Tei index): evaluating its application to myocardial infarction.Hellenic J Cardiol. 2009; 50: 60-65
- Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle.Circulation. 2008; 117: 1436-1448https://doi.org/10.1161/CIRCULATIONAHA.107.653576
- Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients.Chest. 2008; 133: 358-362https://doi.org/10.1378/chest.07-1231
- Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit.Am J Respir Crit Care Med. 2002; 166: 1310-1319https://doi.org/10.1164/rccm.200202-146CC
- Influence of pneumoperitoneum and patient positioning on preload and splanchnic blood volume in laparoscopic surgery of the lower abdomen.J Clin Anesth. 2001; 13: 244-249https://doi.org/10.1016/s0952-8180(01)00242-2
- Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function.Int J Cardiol. 2007; 115: 86-89https://doi.org/10.1016/j.ijcard.2006.01.017
- Positive end-expiratory pressure during laparoscopy: cardiac and respiratory effects.J Clin Anesth. 2013; 25: 314-320https://doi.org/10.1016/j.jclinane.2013.01.011
- Positive end-expiratory pressure does not decrease cardiac output during laparoscopic liver surgery: a prospective observational evaluation.HPB (Oxford). 2017; 19: 36-41https://doi.org/10.1016/j.hpb.2016.10.009
- Optimum end-expiratory airway pressure in patients with acute pulmonary failure.N Engl J Med. 1975; 292: 284-289https://doi.org/10.1056/NEJM197502062920604
- Should PEEP titration be based on chest mechanics in patients with ARDS?.Respir Care. 2016; 61: 876-890https://doi.org/10.4187/respcare.04657
- Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.Lancet Respir Med. 2016; 4: 272-280https://doi.org/10.1016/S2213-2600(16)00057-6
- Electrical impedance tomography-guided PEEP titration in patients undergoing laparoscopic abdominal surgery.Med (Baltim). 2016; 95: e3306https://doi.org/10.1097/MD.0000000000003306
- Association between arterial hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies.Crit Care Med. 2015; 43: 1508-1519https://doi.org/10.1097/CCM.0000000000000998
Published online: December 17, 2022
Accepted: December 9, 2022
Received in revised form: December 8, 2022
Received: August 1, 2022
© 2022 Published by Elsevier Inc.