Pneumoperitoneum deteriorates intratidal respiratory system mechanics: an observational study in lung-healthy patients.

Abstract

Pneumoperitoneum during laparoscopic surgery leads to atelectasis and impairment of oxygenation. Positive end-expiratory pressure (PEEP) is supposed to counteract atelectasis. We hypothesized that the derecruiting effects of pneumoperitoneum would deteriorate the intratidal compliance profile in patients undergoing laparoscopic surgery. In 30 adult patients scheduled for surgery with pneumoperitoneum, respiratory variables were measured during mechanical ventilation. We calculated the dynamic compliance of the respiratory system (C RS) and the intratidal volume-dependent C RS curve using the gliding-SLICE method. The C RS curve was then classified in terms of indicating intratidal recruitment/derecruitment (increasing profile) and overdistension (decreasing profile). During the surgical interventions, the PEEP level was maintained nearly constant at 7cm H2O. Data are expressed as mean [confidence interval]. Baseline C RS was 60 [54-67]mLcm H2O-1. Application of pneumoperitoneum decreased C RS to 40 [37-43] mLcm H2O-1 which partially recovered to 54 [50-59] mLcm H2O-1 (P<0.001) after removal but remained below the value measured before pneumoperitoneum (P<0.001). Baseline compliance profiles indicated intratidal recruitment/derecruitment in 48% patients. After induction of pneumoperitoneum, intratidal recruitment/derecruitment was indicated in 93% patients (P<0.01), and after removal intratidal recruitment/derecruitment was indicated in 59% patients. Compliance profiles showing overdistension were not observed. Analyses of the intratidal compliance profiles reveal that pneumoperitoneum during laparoscopic surgery causes intratidal recruitment/derecruitment which partly persists after its removal. The analysis of the intratidal volume-dependent C RS profiles could be used to guide intraoperative PEEP adjustments during elevated intraabdominal pressure.