Abstract
The study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury.Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928
Highlights
Laparoscopic surgery has been widely adopted in different surgery fields, due to its advantages such as minimal incision, less stress response and fewer blood loss
The optimal PEEP titration determined by Cdyn is relatively simple and practical, which has been proven to reduce the incidence of postoperative respiratory complications (PPCs) in patients with abdominal surgery [13]
We investigated the efficacy of Pressure-controlled ventilation (PCV)-VG together with individualized PEEP on lung mechanics, oxygenation parameters and lung injury in patients underwent laparoscopic surgery in the Trendelenburg position
Summary
Laparoscopic surgery has been widely adopted in different surgery fields, due to its advantages such as minimal incision, less stress response and fewer blood loss. C O2 pneumoperitoneum combined with Trendelenburg position is commonly used to provide adequate exposure of surgical viewing and space These methods have a major impact on the cardiovascular and pulmonary systems such as mean arterial pressure increased, increased Ppeak and decreased pulmonary compliance, and increases the risk of atelectasis or barotrauma because of. PCV-VG, a relatively innovative ventilation mode, has recently been introduced in the field of anesthesiology It has the features of VCV and PCV, which delivers a target VT with a decelerating airflow, reduces high airway pressure-induced airway and alveolar damage and ensures effective alveolar ventilation according to the patient’s lung compliance [7, 8]. Whether the application of PCV-VG together with individualized PEEP can provide the lung-protective effect in patients undergoing laparoscopic surgery in the Trendelenburg position is unclear. We investigated the efficacy of PCV-VG together with individualized PEEP on lung mechanics, oxygenation parameters and lung injury in patients underwent laparoscopic surgery in the Trendelenburg position
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