Document Detail


Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum.
MedLine Citation:
PMID:  15954959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Laparoscopic surgery usually requires the use of a pneumoperitoneum by insufflating gas in the peritoneal space. The gas most commonly used for insufflation is carbon dioxide. Increased intra-abdominal pressure causes cephalad displacement of the diaphragm resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. The aim of this prospective study was to investigate the effect of prolonged intraperitoneal gas insufflation on arterial oxygenation and hemodynamics during mechanical ventilation with and without positive end-expiratory pressure (PEEP). METHODS: Twenty patients undergoing totally endoscopic robot-assisted radical prostatectomy were randomly allocated to one of two groups. In the PEEP group (n = 10) a constant PEEP of 5 cmH(2)O was used, whereas in the ZPEEP group (n = 10) no PEEP was used. RESULTS: Application of PEEP (5 cmH(2)O) resulted in significantly higher P(a)O(2) levels after 3 h (182 +/- 49 vs. 224 +/- 35 mmHg) and 4 h (179 +/- 48 vs. 229 +/- 29 mmHg) of pneumoperitoneum; after desufflation, P(a)O(2) values decreased significantly below preinsufflation values. While there were no significant differences in heart rate, central venous pressure (CVP) and mean arterial blood pressure (MAP) during pneumoperitoneum between both groups, baseline values in CVP and MAP differed significantly between both groups with higher levels in the ZPEEP group. CONCLUSION: The application of a constant positive airway pressure of 5 cmH(2)O preserves arterial oxygenation during prolonged pneumoperitoneum.
Authors:
D Meininger; C Byhahn; S Mierdl; K Westphal; B Zwissler
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  49     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-15     Completed Date:  2005-10-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  778-83     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe-University Hospital, Frankfurt, Germany. dirk_meininger@gmx.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia
Carbon Dioxide / blood
Endoscopy
Hemodynamics
Humans
Male
Middle Aged
Oxygen / blood*
Pneumoperitoneum, Artificial*
Positive-Pressure Respiration*
Prostatectomy
Respiration, Artificial
Respiratory Function Tests
Treatment Outcome
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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