Does Lung Compliance Optimization Through PEEP Manipulations Reduce the Incidence of Postoperative Hypoxemia in Laparoscopic Bariatric Surgery? A Randomized Trial
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In obese patients (OP), the best intraoperative ventilation strategy remains to be defined. Dynamic lung compliance (Cdyn) and dead space fraction are indicators of efficient ventilation at an optimal positive end-expiratory pressure (PEEP). Herein, we investigated whether intraoperative dynamic lung compliance optimization through PEEP manipulations affects the incidence of postoperative hypoxemia (SpO2 < 90%) in OP undergoing laparoscopic bariatric surgery (LBS).
This was a single-center, prospective, randomized controlled study conducted from July 2013 to December 2015. After obtaining institutional review board approval and informed consent, 100 OP undergoing LBS under volume-controlled ventilation (tidal volume 8 mL/kg of ideal body weight) were randomized according to the PEEP level maintained during the surgery. In the control group, a PEEP of 10 cm H2O was maintained, while in the intervention group, the PEEP was adapted to achieve the best dynamic lung compliance. Anesthesia and analgesia were standardized. The patients received supplemental nasal oxygen on the first postoperative day and were monitored up to the second postoperative day with a portable pulse oximeter.
Demographics were similar between groups. There was no difference in the incidence of hypoxemia during the first 2 postoperative days (control: 1.3%; intervention: 2.1%; p = 0.264).
The incidence of postoperative hypoxemia was not reduced by an open-lung approach with protective ventilation strategy in obese patients undergoing LBS. A pragmatic application of a PEEP level of 10 cm H2O was comparable to individual PEEP titration in these patients.
KeywordsLaparoscopic bariatric surgery Mechanical ventilation Anesthetic management Lung compliance Positive end-expiratory pressure Postoperative hypoxemia
Assistance with the study: The authors would like to thank the following persons from the Department of Anaesthesiology, CHU Brugmann-HUDERF, Brussels, Belgium, who kindly performed the protocol study in the operating room: Ida Stany M.D., Robert Tircoveanu M.D., Yannick Ciccarella M.D., Jean-Louis Majcher M.D., Christiane Dzechi M.D., and Muj Mulaj M.D.
This work was supported only by CHU Brugmann-HUDERF departmental sources and the Brugmann foundation.
Compliance with Ethical Standards
Our study was a prospective, randomized controlled study, approved by the Institutional Ethics Committee. Written informed consent was obtained from all participating subjects. This manuscript adheres to the applicable Enhancing the Quality and Transparency of Health Research (EQUATOR) guidelines.
Conflicts of Interest
The authors declare that they have no conflict of interest.
Ethical and Consent Statement
Ethical and consent statement provided by the Institutional Ethics Committee. Written informed consent was obtained from all participating subjects.
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