title: Alveolar recruitment strategy and high positive end-expiratory pressure levels do not affect hemodynamics in morbidly obese intravascular volume-loaded patients.
abstract: 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.
authors.affiliation: Clinic of Anesthesiology, University Hospital Hamburg-Eppendorf, Germany. shb@csem.ch
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Bohm
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Thamm
authors.forename: Alexandra
authors.initials: A
authors.lastname: von Sandersleben
authors.forename: Katrin
authors.initials: K
authors.lastname: Bangert
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Langwieler
authors.forename: Gerardo
authors.initials: G
authors.lastname: Tusman
authors.forename: Tim G
authors.initials: TG
authors.lastname: Strate
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Standl
mesh_terms: 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*