Intraoperative right heart function with individualized mechanical ventilation in laparoscopic surgery with Trendelenburg positioning: A randomized-controlled study

Abstract

BackgroundThe intraoperative effects of mechanical ventilation with individualized positive end-expiratory pressure guided by dynamic compliance on right heart function remains undefined. ObjectivesTo investigate whether individualized ventilation is superior to standard ventilation in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg position. MethodsForty patients who underwent abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric positive end-expiratory pressure [PEEP]) and Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured using transesophageal echocardiography, which included tricuspid annular plane systolic excursion, early-to-late filing ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area ratio during mechanical ventilation. ResultsNo significant difference in the tricuspid annular plane systolic excursion or early-to-late filling ratio of the right ventricle was noted between the groups during the whole procedure (P>0.05). We noticed an increase in right ventricular end-diastolic area/left ventricular end-diastolic area ratio at T0 vs. T2 in Group T (0.53±0.02 vs. 0.60±0.06, respectively; P = 0.0208) and Group I (0.54±0.01 vs. 0.62±0.06, respectively; P = 0.0018). ConclusionsIntraoperative lung-protective ventilation with dynamic compliance-guided PEEP does not have obvious side effects on the right heart function when compared with standard protective ventilation during laparoscopic surgery in the Trendelenburg position.