Alveolar recruitment strategy and high positive end-expiratory pressure levels do not affect hemodynamics in morbidly obese intravascular volume-loaded patients.
We evaluated the effect of the alveolar recruitment strategy and high positive end-expiratory pressure (PEEP) on hemodynamics in 20 morbidly obese (body mass index 50 +/- 9 kg/m2), intravascular volume-loaded patients undergoing laparoscopic surgery. The alveolar recruitment strategy was sequentially performed with and without capnoperitoneum and consisted of an upward PEEP trial, recruitment with 50-60 cm H2O of plateau pressure for 10 breaths, and a downward PEEP trial. Recruitment and high PEEP did not cause significant disturbances in any hemodynamic variable measured by systemic and pulmonary artery catheters. Transesophageal echocardiography revealed no differences in end-diastolic areas or evidence of segmental abnormalities in wall motion.
Bohm
Stephan H
SH
Clinic of Anesthesiology, University Hospital Hamburg-Eppendorf, Germany. shb@csem.ch
Thamm
Oliver C
OC
von Sandersleben
Alexandra
A
Bangert
Katrin
K
Langwieler
Thomas E
TE
Tusman
Gerardo
G
Strate
Tim G
TG
Standl
Thomas G
TG
D000328:Adult; D001810:Blood Volume / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011650:Pulmonary Alveoli / Q000502:physiology*