Features of respiratory therapy in patients with obesity during laparoscopic surgeries

O.M. Turkevych, Ya.M. Pidgirnyy, O.P. Zakotyanskyi

Abstract


In this clinical trial, we have studied lung respiratory properties of 40 patients with varying degrees of obesity during laparoscopic surgeries. All the patients were divided into 4 groups: three control (group 1 — persons without obesity or with overweight, group 2 — individuals with degrees 1 and 2 of obesity, group 3 — patients with morbid obesity), and one experimental group (group 4) — persons with degrees 1 and 2 of obesity, who were treated with preoperative non-invasive continuous positive airway pressure (CPAP) therapy and whose parameters of mechanical ventilation were optimized by changing positive end-expiratory pressure (PEEP) levels and using recruitment maneuver. We have been evaluating the following lung properties: static compliance, average dynamic compliance, general airway resistance, peak inspiratory pressure, plateau pressure and mean airway pressure. All these parameters were determined in few specific moments (points) of general anesthesia: control point 1 — after the intubation, control point 2 — after intraabdominal pressure increased to 15 mmHg, control point 3 — when intraabdominal pressure decreased to 10 mmHg, and control point 4 — after normalizing the level of intraabdominal pressure. In experimental group, we’ve additionally determined those properties after changing PEEP level to 10 cmH2O. The use of preoperative non-invasive CPAP therapy and enhanced intraoperative PEEP improves the respiratory properties of the lungs, especially in obese patients with concomitant pulmonary pathology during laparoscopic surgery. Intraabdominal pressure at the level of 15 mmHg, which is often used in laparoscopic interventions, negatively affects respiratory mechanics. PEEP at the level of 5 cmH2O is insufficient to maintain “open lungs” in patients with obesity during laparoscopic surgery with intraabdominal hypertension. Non-invasive CPAP therapy and PEEP at the level of 10 cmH2O make it possible to keep satisfactory lung compliance, reduce the general resistance of the respiratory tract, prevent the formation of atelectasis and possibly further reduce the time of weaning from the mechanical ventilation.

Keywords


respiratory therapy; artificial ventilation; obesity; laparoscopy

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DOI: https://doi.org/10.22141/2224-0586.3.90.2018.129489

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