Abstract
BackgroundObesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition.ObjectiveTo assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery.MethodsA systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations.ResultsFourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenation p = 0.03 (MD 79.93), higher plateau pressure p < 0.00001 (MD 7.30), higher mean airway pressure p < 0.00001 (MD 6.61), and higher compliance p < 0.00001 (MD 21.00); when comparing RM + Zero end-expiratory pressure (ZEEP) vs RM + PEEP 5 or 10 cmH2O, RM associated with PEEP led to better oxygenation p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchange p = 0.003 (MD 36.00) and compliance p = 0.0003 (MD 3.00).ConclusionThere is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).
Highlights
Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics
A correlation has been found between a high BMI and an increase in breathing effort and a reduction in oxygenation levels, which may lead to atelectasis and slower weaning from mechanical ventilation [6, 7]
No standard ventilation strategy has been established for obese patients, there is some evidence that recruitment maneuvers (RM) combined with Positive
Summary
Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition. Body mass index (BMI) values above 30 Kg/m [2] can result in a reduction in life expectancy similar to that caused by smoking [2, 3]. Bariatric surgery is an effective intervention against weight gain and the majority of people who undergo such surgery show an improvement in, or the resolution of, conditions. Anesthetic induction in obese patients can result in a significant reduction in respiratory compliance and increase resistance and pressure in the airway [5]. A correlation has been found between a high BMI and an increase in breathing effort and a reduction in oxygenation levels, which may lead to atelectasis and slower weaning from mechanical ventilation [6, 7].
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