title: Positive end-expiratory pressure during laparoscopy: cardiac and respiratory effects.
abstract: OBJECTIVE
  To determine the effect of positive end-expiratory pressure (PEEP) on the respiratory system and on cardiac function.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  60 ASA physical status 1 women scheduled for pelvic laparoscopic surgery.
  
  
  METHODS
  Patients were ventilated normally during surgery; PEEP was modified depending on patient group allocation. Group A was the control group and did not receive PEEP. Group B received PEEP 5 cmH2O and Group C received PEEP 10 cmH2O.
  
  
  METHODS
  Respiratory parameters measured were partial pressure of arterial oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and end-tidal carbon dioxide tension (ETCO2). Cardiac parameters measured were left ventricular end-diastolic volume index (LVEDVI), ie, ratio of LVEDV/body surface area (BSA; [LVEDVI = end-diastolic volume [EDV]/BSA); left ventricular (LV) systolic function, tricuspid annular plane systolic excursion (TAPSE), right ventricular (RV) fractional area change (FAC), RV dimensions in the apical 4-chamber view, tracing basal and mid-cavity minor dimensions and longitudinal dimension, cardiac index, systolic pulmonary artery pressure (PASP), and systolic RV pressure (RVSP). Respiratory and cardiac measurements were recorded at T0 (baseline); T1 (after anesthesia induction, before pneumoperitoneum induction); at 10 (T2), 20 (T3), and 30 (T4) minutes after CO2 insufflation; and at the end of surgery (T5).
  
  
  RESULTS
  Ventilation with PEEP at 10 cm H2O led to significant improvement in both respiratory and cardiac parameters. A reduction in pulmonary vascular resistance and enhanced washout of expiratory CO2 occurred. Ten and, to a lesser extent, 5 cm H2O of PEEP decreased LV stroke work.
  
  
  CONCLUSIONS
  Ventilation with PEEP (up to 10 cm H2O) recruits the hypoventilated areas of the lungs and reduces cardiac afterload.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart in Rome, 00168 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scagliusi
authors.forename: Francesca
authors.initials: F
authors.lastname: Bevilacqua
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Isgrò
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marana
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Marana
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Echocardiography; Gas exchange; Laparoscopy; Pneumoperitoneum; Positive end-expiratory pressure; Stroke work