Abstract
BackgroundThis study aimed to evaluate the impact of patients' positioning before and after intubation with mechanical ventilation, and after extubation on the lung function and blood oxygenation of patients with morbid obesity, who had a laparoscopic sleeve gastrectomy.MethodsPatients with morbid obesity (BMI ≥ 30 kg/m2, ASA I – II grade) who underwent laparoscopic sleeve gastrectomy at our hospital from June 2018 to January 2019 were enrolled in this prospective study. Before intubation, after intubation with mechanical ventilation, and after extubation, arterial blood was collected for blood oxygenation and gas analysis after posturing the patients at supine position or 30° reverse Trendelenburg position (30°-RTP).ResultsA total of 15 patients with morbid obesity were enrolled in this self-compared study. Pulmonary shunt (Qs/Qt) after extubation was significantly lower at 30°-RTP (18.82 ± 3.60%) compared to that at supine position (17.13 ± 3.10%, p < 0.01). Patients' static lung compliance (Cstat), during mechanical ventilation, was significantly improved at 30°-RTP (36.8 ± 6.7) compared to that of those in a supine position (33.8 ± 7.3, p < 0.05). The PaO2 and oxygen index (OI) before and after intubation with mechanical ventilation were significantly higher at 30°-RTP compared to that at supine position, and in contrast, the PA−aO2 before and after intubation with mechanical ventilation was significantly reduced at 30°-RTP compared to that at supine position.ConclusionDuring and after laparoscopic sleeve gastrectomy, patients with morbid obesity had improved lung function, reduced pulmonary shunt, reduced PA−aO2 difference, and increased PaO2 and oxygen index at 30°-RTP compared to that supine position.
Highlights
The prevalence of obesity is increasing worldwide
Patients’ static lung compliance (Cstat) during mechanical ventilation was significantly improved at 30◦ reverse Trendelenburg position (30◦-RTP) (36.8 ± 6.7%) compared to that at supine position (33.8 ± 7.3%, p < 0.01)
It was found that post-extubation Qs/Qt was significantly lower at 30◦RTP compared to that at supine position, that the patients’ static lung compliance (Cstat) during mechanical ventilation was significantly improved at 30◦-RTP compared to that at supine position, that PaO2 and oxygen index before and after intubation for mechanical ventilation were significantly higher at 30◦-RTP compared to that at supine position, and, in contrast, the PA−aO2 before and after intubation for mechanical ventilation was significantly reduced at 30◦RTP compared to that at supine position
Summary
The prevalence of obesity is increasing worldwide. It has been reported by the National Health and Nutritional Examination Survey (NHANES) that the prevalence of obesity in the USA was 40.4% for women and 35% for men in 2016 [1]. Pulmonologists are confronted with properly ventilating these patients, along with maintaining normal lung function when they emerge from general anesthesia This is due to patients with obesity having altered respiratory mechanics and metabolic syndrome/s [3, 4]. In this regard, compared to a normal healthy person, significant alteration of respiratory mechanics exists in obesity, which is further augmented with general anesthesia or with underlying lung diseases. These alterations include a reduced functional residual capacity (FRC), reduced lung and chest wall compliance, increased lung resistance, reduced oxygenation, and increased work of breathing [5, 6]. After intubation with mechanical ventilation, and after extubation, arterial blood was collected for blood oxygenation and gas analysis after posturing the patients at supine position or 30◦ reverse Trendelenburg position (30◦-RTP)
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