title: Exploring for the safer ventilation method in laparoscopic urologic patients? Conventional or low tidal?
abstract: BACKGROUND
  To study the effects of low tidal volume with positive end-expiratory pressure (PEEP) on arterial blood gases of patients undergoing laparoscopic urologic surgeries.
  
  
  METHODS
  Eighty-six laparoscopic urologic patients were enrolled in this study. Patients were randomized into two groups according to the ventilatory settings. In the conventional group (Group C) (n=43), the tidal volume was 10 mL/kg, and the PEEP was set at 0 cm of H2O. In the low tidal volume with PEEP group (Group LP), the tidal volume was 6 mL/kg, with PEEP of 5 cm of H2O. In both groups total minute volume was 6 L/kg. Peak and plateau airway pressure (PPEAK and PPLAT, respectively) and arterial blood gases were recorded before pneumoperitoneum (PNP) (T1) and the first and third hour (T3) after PNP induction and also after extubation in the intensive care unit. Additionally, heart rate, mean arterial pressure, and peripheral O2 saturation of hemoglobin were recorded.
  
  
  RESULTS
  Heart rate, PPEAK, and PPLAT values were similar in both groups. Partial arterial O2 pressure values measured postoperatively were significantly higher in Group LP, whereas those measured before PNP induction were similar (P=.014 and P=.056, respectively). Compared with the baseline, partial arterial CO2 pressure values measured at T1 and at T3 after PNP induction were significantly higher in Group C than in Group LP (P<.001). The pH values of Group C at T1 and at T3 postoperatively were significantly lower than the values of Group LP (P<.001). Extubation times were significantly lower in Group LP.
  
  
  CONCLUSIONS
  The results of the present study suggest that low tidal volume with PEEP application may be a good alternative for preventing high CO2 levels and yielding better oxygenation and lower extubation times in patients undergoing prolonged laparoscopic urology.
authors.affiliation: 1 Department of Anesthesiology and Reanimation, Afyon Kocatepe University , Afyon, Turkey .
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Ela
authors.forename: Elif Doğan
authors.initials: ED
authors.lastname: Bakı
authors.forename: Mutlu
authors.initials: M
authors.lastname: Ateş
authors.forename: Serdar
authors.initials: S
authors.lastname: Kokulu
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Keleş
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karalar
authors.forename: Hasan
authors.initials: H
authors.lastname: Şenay
authors.forename: Remziye Gül
authors.initials: RG
authors.lastname: Sıvacı
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006339:Heart Rate; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D015656:Respiratory Mechanics; D013990:Tidal Volume; D013520:Urologic Surgical Procedures / Q000379:methods*
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen