Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy.
BACKGROUND
Applying appropriate positive end-expiratory pressure (PEEP) to corresponding intra-abdominal pressure (IAP) can improve gas exchange during capnoperitoneum without any hemodynamic effects.


METHODS
A total of 75 patients were randomly allocated to group 0PEEP (n=25), group 5PEEP (n=25), and group 10PEEP (n=25) according to the level of PEEP, in whom capnoperitoneum was created with IAP of 14, 8, and 14 mm Hg, respectively. Hemodynamic and respiratory parameters were recorded up to 30 minutes after capnoperitoneum.


RESULTS
In 0PEEP group, mean end-tidal carbon dioxide demonstrated significant rise 2 minutes after capnoperitoneum and plateaued at about 15 minutes but remained at high level for up to 30 minutes when compared with the 5PEEP and 10PEEP groups (P<0.05). Correspondingly, the mean PaCO2 (48.0±4.1 mm Hg) for the 0PEEP group was higher at 30 minutes when compared with 5PEEP (37.8±2.7 mm Hg) and 10PEEP (37.2±3.9 mm Hg) groups. The oxygenation was better preserved in 5PEEP and 10PEEP groups with significantly higher PaO2/Fio2 ratio. Heart rate, mean arterial pressure, and cardiac output remained stable throughout the study in all the 3 groups.


CONCLUSIONS
Application of appropriate PEEP corresponding to the IAP helped maintain CO2 elimination and improved oxygenation without any hemodynamic disturbance in patients undergoing laparoscopic cholecystectomy.
Departments of *Anaesthesiology and Critical Care §Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research †Department of Anaesthesiology, Sri Lakshmi Narayana Institute of Medical Sciences ‡Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
Pankaj
P
Kundra
Yamini
Y
Subramani
M
M
Ravishankar
Sarath C
SC
Sistla
Mahesh
M
Nagappa
T
T
Sivashanmugam
D034841:Abdominal Cavity / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D001784:Blood Gas Analysis; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D016037:Single-Blind Method; D055815:Young Adult