[Effectiveness of a recruitment manoeuvre and positive end-expiratory pressure on respiratory mechanics during laparoscopic bariatric surgery].
OBJECTIVE
To evaluate recruitment manoeuvre (RM) efficiency associated with a 10 cmH(2)O positive end expiratory pressure (PEEP) on respiratory mechanic estimated by lung compliance (Ctp) and PEEP to ZEEP expiratory volume delta (Delta VTE) during laparoscopic bariatric surgery in patients with morbid obesity.


METHODS
Prospective randomized study.


METHODS
Twenty-six obese patients (BMI>40 kg/m(2)) undergoing laparoscopic bariatric surgery. The recruitment group received an RM followed by a 10 cmH(2)O PEP versus only 10 cmH(2)O PEP in the control group. Ctp was measured during the intervention and functional residual capacity (FRC) was estimated measuring Delta VTE during a PEP to ZEP manoeuvre. Mann and Whitney tests as well as a t-test were used (significance p<0.05).


RESULTS
In the RM group, a significant improvement of 52+/-14 ml/cmH(2)O was noted versus a 36+/-10 ml/cmH(2)O in the PEP group (p=0,004). This improvement was transitory and no statistically significant Delta VTE difference was noted between the groups at the end of the intervention (360 [90-770]ml [MRA] and 310 [190-450]ml [PEP]).


CONCLUSIONS
In patients with morbid obesity undergoing laparoscopic bariatric surgery, an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone. The RM was well tolerated.
Tafer
N
N
Service d'anesthésie-réanimation II, CHU de Bordeaux, groupe hospitalier Sud, avenue de Magellan, Pessac cedex, France.
Nouette-Gaulain
K
K
Richebé
Ph
P
Rozé
H
H
Lafargue
M
M
Janvier
G
G
D000328:Adult; D005105:Expiratory Reserve Volume; D005260:Female; D005652:Functional Residual Capacity; D015391:Gastroplasty; D006439:Hemodynamics; D006801:Humans; D010535:Laparoscopy; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D010100:Oxygen / Q000097:blood; D011028:Pneumoperitoneum, Artificial; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D015656:Respiratory Mechanics
D010100:Oxygen