Perioperative lung-protective ventilation during laparoscopic operations in obese patients
Background. In this clinical study, main methods of lung-protective ventilation were used in patients with obesity class 2–3 during laparoscopic abdominal operations. The main purpose of the study was to determine the effectiveness of lung-protective ventilation towards resorption atelectasis. Materials and methods. Totally 24 patients were divided into 3 groups: 1 control group and 2 study groups. Patients from group 1 were ventilated without using high positive end-expiratory pressure (PEEP) levels and recruitment maneuvers (RMs). High levels of PEEP (10–15 cm H2O) were used for patients in group 2; RMs plus high PEEP levels were used in group 3. Static lung compliance, middle intrathoracic pressure and average arterial blood pressure were measured in four control points of general anesthesia: control point 1 — after the intubation, control point 2 — after raising the intraabdominal pressure to 15 mmHg, control point 3 — after decreasing intraabdominal pressure to 10 mmHg and control point 4 — after normalizing the level of intraabdominal pressure. RMs were performed using sustained inflation method (40 × 40), after each control point. Results. The best results were obtained in group 3 of patients (RMs + PEEP), in which static lung compliance was significantly higher than in other groups. Conclusions. An intraoperative combination of alveolar recruitment and elevated PEEP level leads to improvement of static lung compliance, which may indicate a decrease in the percentage of atelectatic pulmonary tissue. Hemodynamic instability was not observed after the recruitment and PEEP. Previously, these methods can be considered to be safe during laparoscopic operations.
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