Driving pressure as a component of respiratory monitoring of obese patients in laparoscopic surgeries
Background. There is a proven risk of lung complications during general anesthesia with mechanical ventilation. When performing laparoscopy, respiratory mechanics and gas exchange are impaired because of pneumoperitoneum and atelectasis formation. All these complications can be combined under the concept of ventilator-induced lung injury. In this article, we tried to investigate one of the respiratory variables, driving pressure (ΔP), in the group of patients who are most at risk — obese patients, during laparoscopic surgery. Materials and methods. We examined 20 patients with body mass index of 35.0–39.9 kg/m2 undergoing laparoscopic cholecystectomy. They were divided into 2 groups: control and study. We used lung protective strategy. ΔP and static lung compliance (CRS) were determined when intraabdominal pressure was set at the level of 15 mmHg. An initial tidal volume (Vt) of 6 ml/kg of predicted, not actual body weight was used. The predicted body weight for men was calculated as follows: 50.0 (kg) + 0.91 × (height (cm) – 152.4); and for women: 45.5 (kg) + 0.91 × (height (cm) – 152.4). In the control group, positive end-expiratory pressure (PEEP) was set at the level of 5 cmH2O and in the study group — 10 cmH2O. Driving pressure was calculated using a formula: ΔP = Vt/CRS. Results. CRS was lower by 27.6 % (34.9/48.2 ml/mmH2O) in the control group (PEEP = 5 cmH2O). Middle ΔP in control and study groups were 14.6 and 10.5 cmH2O, respectively. The use of higher PEEP (10 cmH2O) was accompanied by an increase in CRS and a significant decrease in ΔP (by 28 %) in the study group. Conclusions. Searching for the optimal level of PEEP is still an unresolved problem in laparoscopic surgery, especially in obese patients, but preliminary findings suggest the need for further research and monitoring of CRS and especially ΔP as possible predictors for the prevention of ventilator-inducted lung injury. In obese patients undergoing laparoscopic operations, lung protective strategy was suitable and parameters of respiratory mechanics were improved.
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