title: Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.
abstract: To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy.
  
  
  
  We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression.
  
  
  
  Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038).
  
  
  
  In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Ehieli
authors.affiliation: Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.|Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Howard
authors.affiliation: University of Missouri Health System, Columbia, Missouri, USA.
authors.forename: Terri G
authors.initials: TG
authors.lastname: Monk
authors.affiliation: Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.|Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Ferrandino
authors.affiliation: Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.|Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.affiliation: Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.|Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Walther
authors.affiliation: Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.|Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011175:Positive-Pressure Respiration; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures
keywords: positive end-expiratory pressure; prostate cancer; prostatectomy; retropubic; robotic surgical procedures; surgical blood loss