[EngO3-6] Effect of intraoperative PEEP setting guided by esophageal pressure measurement on oxygenation during laparoscopic gynecologic surgery
Background: Setting of positive end-expiratory pressure (PEEP) may have an important role in respiratory management during laparoscopic surgery(1-3). However, there is no consensus on the optimal PEEP level or the best method to set PEEP during laparoscopic surgery. The aim of this study was to investigate whether setting of PEEP guided by measurement of esophageal pressure would affect oxygenation during laparoscopic gynecologic surgery
Method: This was a randomized controlled study conducted from April to June 2018. Forty-four patients were equally divided into the intervention group (ESO) and the control group (CON). In ESO, PEEP was set according to esophageal pressure measured to maintain transpulmonary pressure during expiration between 0 and 5 cm H2O. In CON, PEEP was constantly set at 5 cm H2O. Gas exchange, lung mechanics, and hemodynamic parameters were recorded after induction and intubation (T0) and at 15 and 60 minutes after gas insufflation (T1 and T2, respectively) and data were analysed and compared within and between groups. A p-value of less than 0.05 was considered statistical significance.
Results: The average age of all patients was 41.1±7.6 years old and 25 (56.8%) of theses had ASA I. The average anesthetic and insufflation time were 191±70 and 136±63 minutes, respectively. PEEP during T1 and T2 were significantly higher in ESO than CON (T1, 12.5±1.9 vs. 5.0±0.0 cm H2O, p<0.001 and T2, 12.4±1.9 vs. 5.0±0.0 cm H2O, p<0.001). In CON, PaO2 during T1 and T2 were significantly dropped from T0 (T0, 203±44 vs. T1, 183±41 mm Hg, p=0.012 and vs. T2, 184±39 mm Hg, p=0.008). In ESO, there was no significant change in PaO2 from T0 during T1 and T2 (T0, 211±35 vs. T1, 202±42 mm Hg, p=0.124 and vs. T2, 204±32 mm Hg, p=0.177). However, when compared between groups, the changes in PaO2 were not significantly different (T1; CON, -20±33 vs. ESO, -9±25 mm Hg, p=0.220 and T2; CON, -19±30 vs. ESO, -6±21, p=0.122). There was no significant difference between groups in terms of hemodynamic parameters, adverse events, and hospital length of stay.
Conclusions: PEEP setting guided by esophageal pressure measurement might prevent deceased oxygenation in patients underwent laparoscopic gynecologic surgery. Although, this change did not reach statistical significance. A larger trial might be warranted.
References:
1. Maracaja-Neto LF et al. Acta Anaesthesiol Scand. 2009;53(2):210-7.
2. Lee HJ et al. Korean J Anesthesiol. 2013;65(3):244-50.
3. Spadaro S et al. Br J Anaesth. 2016;116(6):855-61.
Method: This was a randomized controlled study conducted from April to June 2018. Forty-four patients were equally divided into the intervention group (ESO) and the control group (CON). In ESO, PEEP was set according to esophageal pressure measured to maintain transpulmonary pressure during expiration between 0 and 5 cm H2O. In CON, PEEP was constantly set at 5 cm H2O. Gas exchange, lung mechanics, and hemodynamic parameters were recorded after induction and intubation (T0) and at 15 and 60 minutes after gas insufflation (T1 and T2, respectively) and data were analysed and compared within and between groups. A p-value of less than 0.05 was considered statistical significance.
Results: The average age of all patients was 41.1±7.6 years old and 25 (56.8%) of theses had ASA I. The average anesthetic and insufflation time were 191±70 and 136±63 minutes, respectively. PEEP during T1 and T2 were significantly higher in ESO than CON (T1, 12.5±1.9 vs. 5.0±0.0 cm H2O, p<0.001 and T2, 12.4±1.9 vs. 5.0±0.0 cm H2O, p<0.001). In CON, PaO2 during T1 and T2 were significantly dropped from T0 (T0, 203±44 vs. T1, 183±41 mm Hg, p=0.012 and vs. T2, 184±39 mm Hg, p=0.008). In ESO, there was no significant change in PaO2 from T0 during T1 and T2 (T0, 211±35 vs. T1, 202±42 mm Hg, p=0.124 and vs. T2, 204±32 mm Hg, p=0.177). However, when compared between groups, the changes in PaO2 were not significantly different (T1; CON, -20±33 vs. ESO, -9±25 mm Hg, p=0.220 and T2; CON, -19±30 vs. ESO, -6±21, p=0.122). There was no significant difference between groups in terms of hemodynamic parameters, adverse events, and hospital length of stay.
Conclusions: PEEP setting guided by esophageal pressure measurement might prevent deceased oxygenation in patients underwent laparoscopic gynecologic surgery. Although, this change did not reach statistical significance. A larger trial might be warranted.
References:
1. Maracaja-Neto LF et al. Acta Anaesthesiol Scand. 2009;53(2):210-7.
2. Lee HJ et al. Korean J Anesthesiol. 2013;65(3):244-50.
3. Spadaro S et al. Br J Anaesth. 2016;116(6):855-61.