Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery

S. Spadaro, D. S. Karbing, T. Mauri, E. Marangoni, F. Mojoli, G. Valpiani, C. Carrieri, R. Ragazzi, M. Verri, S. E. Rees, C. A. Volta

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared with laparotomy. The aim of this study was to evaluate the effects of different levels of positive end-expiratory pressure (PEEP) in both types of surgery and to investigate whether higher levels of PEEP should be used during laparoscopic surgery. Methods This prospective observational study included 52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. Results Pulmonary shunt was similar in both groups. However, in laparotomy, a PEEP of 5 cmH2O significantly decreased shunt when compared with ZEEP (12 vs 6%; P=0.001), with additional PEEP having no further effect. In laparoscopic surgery, a significant reduction in shunt (13 vs 6%; P=0.001) was obtained only at a PEEP of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. Conclusion Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the pulmonary compliance. It appears that a more aggressive PEEP level is required to reduce shunt and to maximize compliance in case of laparoscopic surgery.

Original languageEnglish
Pages (from-to)855-861
Number of pages7
JournalBritish Journal of Anaesthesia
Volume116
Issue number6
DOIs
Publication statusPublished - Jun 19 2016

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Positive-Pressure Respiration
Compliance
Laparoscopy
Lung
Lung Compliance
Laparotomy
Pulmonary Atelectasis
Functional Residual Capacity
Pulmonary Ventilation
General Anesthesia
Observational Studies
Perfusion
Prospective Studies

Keywords

  • end-expiratory pressure
  • laparoscopic surgery
  • laparotomy
  • positive
  • pulmonary compliance
  • shunt

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery. / Spadaro, S.; Karbing, D. S.; Mauri, T.; Marangoni, E.; Mojoli, F.; Valpiani, G.; Carrieri, C.; Ragazzi, R.; Verri, M.; Rees, S. E.; Volta, C. A.

In: British Journal of Anaesthesia, Vol. 116, No. 6, 19.06.2016, p. 855-861.

Research output: Contribution to journalArticle

Spadaro, S, Karbing, DS, Mauri, T, Marangoni, E, Mojoli, F, Valpiani, G, Carrieri, C, Ragazzi, R, Verri, M, Rees, SE & Volta, CA 2016, 'Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery', British Journal of Anaesthesia, vol. 116, no. 6, pp. 855-861. https://doi.org/10.1093/bja/aew123
Spadaro, S. ; Karbing, D. S. ; Mauri, T. ; Marangoni, E. ; Mojoli, F. ; Valpiani, G. ; Carrieri, C. ; Ragazzi, R. ; Verri, M. ; Rees, S. E. ; Volta, C. A. / Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery. In: British Journal of Anaesthesia. 2016 ; Vol. 116, No. 6. pp. 855-861.
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abstract = "Background General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared with laparotomy. The aim of this study was to evaluate the effects of different levels of positive end-expiratory pressure (PEEP) in both types of surgery and to investigate whether higher levels of PEEP should be used during laparoscopic surgery. Methods This prospective observational study included 52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. Results Pulmonary shunt was similar in both groups. However, in laparotomy, a PEEP of 5 cmH2O significantly decreased shunt when compared with ZEEP (12 vs 6{\%}; P=0.001), with additional PEEP having no further effect. In laparoscopic surgery, a significant reduction in shunt (13 vs 6{\%}; P=0.001) was obtained only at a PEEP of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. Conclusion Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the pulmonary compliance. It appears that a more aggressive PEEP level is required to reduce shunt and to maximize compliance in case of laparoscopic surgery.",
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AU - Karbing, D. S.

AU - Mauri, T.

AU - Marangoni, E.

AU - Mojoli, F.

AU - Valpiani, G.

AU - Carrieri, C.

AU - Ragazzi, R.

AU - Verri, M.

AU - Rees, S. E.

AU - Volta, C. A.

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N2 - Background General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared with laparotomy. The aim of this study was to evaluate the effects of different levels of positive end-expiratory pressure (PEEP) in both types of surgery and to investigate whether higher levels of PEEP should be used during laparoscopic surgery. Methods This prospective observational study included 52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. Results Pulmonary shunt was similar in both groups. However, in laparotomy, a PEEP of 5 cmH2O significantly decreased shunt when compared with ZEEP (12 vs 6%; P=0.001), with additional PEEP having no further effect. In laparoscopic surgery, a significant reduction in shunt (13 vs 6%; P=0.001) was obtained only at a PEEP of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. Conclusion Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the pulmonary compliance. It appears that a more aggressive PEEP level is required to reduce shunt and to maximize compliance in case of laparoscopic surgery.

AB - Background General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared with laparotomy. The aim of this study was to evaluate the effects of different levels of positive end-expiratory pressure (PEEP) in both types of surgery and to investigate whether higher levels of PEEP should be used during laparoscopic surgery. Methods This prospective observational study included 52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. Results Pulmonary shunt was similar in both groups. However, in laparotomy, a PEEP of 5 cmH2O significantly decreased shunt when compared with ZEEP (12 vs 6%; P=0.001), with additional PEEP having no further effect. In laparoscopic surgery, a significant reduction in shunt (13 vs 6%; P=0.001) was obtained only at a PEEP of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. Conclusion Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the pulmonary compliance. It appears that a more aggressive PEEP level is required to reduce shunt and to maximize compliance in case of laparoscopic surgery.

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