Perioperative lung-protective ventilation during laparoscopic operations in obese patients


  • O.M. Turkevych Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine



artificial ventilation, respiratory therapy, alveolar recruitment, laparoscopy, obesity


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.


Download data is not yet available.


Guldner A., Kiss T., SerpaNeto A., Hemmes S.N., Canet J., Spieth P.M., Rocco P.R., Schultz M.J., Pelosi P., Gama de Abreu M. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers // Anesthesiology. — 2015 Sep. — 123(3). — Р. 692-713. doi: 10.1097/ALN.0000000000000754Andreas

Guldner& Marcelo Gama de Abreu: Intraoperative protective ventilation reduces postoperative pulmonary complications // Anesthesiol Intensivmed Notfallmed Schmerzther. — 2015. — 50(9). — Р. 524-528. DOI: 10.1055/s-0041-103880.

Mazo V., Sabate S., Canet J., Gallart L., de Abreu M.G., Belda J., Langeron O., Hoeft A., Pelosi P. Prospective external validation of a predictive score for postoperative pulmonary complications // Anesthesiology. — 2014 Aug. — 121(2). — Р. 219-31. doi:10.1097/ALN.0000000000000334.

Ladha K., Vidal Melo M.F., McLean D.J., Wande­rer J.P., Grabitz S.D., Kurth T., Eikermann M. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study // BMJ. — 2015, Jul 14. — 351. — h3646. doi: 10.1136/bmj.h3646.

Canet J., Gallart L., Gomar C., Paluzie G., Vallès J., Castillo J., Sabaté S., Mazo V., Briones Z., Sanchis J. Prediction of Postoperative Pulmonary Complications in a Populations-based Surgical Cohort // Anesthesiology. — 2010 Dec. — 113(6). — Р. 1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a.

Pelosi P., Gama de Abreu M., Rocco P.R. New and conventional strategies for lung recruitment in acute respiratory di­stress syndrome // Crit. Care. — 2010. — 14(2). — Р. 210. doi: 10.1186/cc8851.

Valenza F., Chevallard G., Fossali T., Salice V., Pizzocri M., Gattinoni L. Management of mechanical ventilation during laparoscopic surgery // Best Practice & Research Clinical Anaesthesiology. — 2010. — 24. — Р. 227-41. PMID: 20608559.

Putensen C., Muders T., Kreyer S., Wrigge H. Alveolar ventilation and recruitment under lung protective ventilation // Anеsthesiol Intensivmed Notfallmed Schmerzther. — 2008. — 43(11/12). — Р. 770-777. DOI: 10.1055/s-0028-1104617.

Carol Hodgson et al. A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome // Crit. Care. — 2011. — 15(3). — Р. 133. — Published online 2011 Jun 2. doi: 10.1186/cc10249.

Odenstedt H., Lindgren S., Olegеrd C., Erlandsson K., Lethvall S., Aneman A., Stenqvist O., Lundin S. Slow mode­rate pressure recruitment maneuver minimizes negative circulatoryand lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography // Intensive Care Med. — 2005 Dec. — 31(12). — Р. 1706-14. Epub. 2005, Sep 22.

Сатишур О.Е. Механическая вентиляция легких. — М.: Медицинская литература, 2007. — 352 с.



How to Cite

Turkevych, O. (2021). Perioperative lung-protective ventilation during laparoscopic operations in obese patients. EMERGENCY MEDICINE, (1.96), 85–89.



Original Researches