Recruitment Maneuvers and PEEP-guided Electrical Impedance Tomography for Abdominal Laparoscopic Surgery Patients
Impact of Recruitment Maneuvers and PEEP-guided Electrical Impedance Tomography on Regional Ventilation, Gas Exchange, and Pulmonary Mechanics in in Abdominal Laparoscopic Surgery Patients
Nguyen Dang Thu
70 participants
Aug 1, 2024
INTERVENTIONAL
Conditions
Summary
Abdominal laparoscopy is widely utilized due to its benefits, including minimal invasiveness, improved cosmetic outcomes, and shorter hospital stays. However, the use of intraoperative pneumoperitoneum and general anesthesia with mechanical ventilation may lead to postoperative pulmonary complications, such as atelectasis. This condition can result in diminished respiratory mechanics and impaired gas exchange. In recent years, intraoperative lung-protective mechanical ventilation techniques, including recruitment maneuvers (RMs) and positive end-expiratory pressure (PEEP) strategies, have gained popularity. These approaches aim to prevent the repeated collapse and reopening of alveoli, thereby reducing the risk of atelectasis. Nonetheless, determining the optimal PEEP level for individual patients remains a complicated and unresolved issue. Electrical impedance tomography (EIT) is a bedside imaging technique that assesses regional ventilation distribution, providing a method for personalizing PEEP settings in mechanically ventilated patients. By addressing the competing risks of alveolar overdistension and collapse, EIT enhances the precision of PEEP titration. This study aims to compare the effects of recruitment maneuvers and EIT-guided PEEP selection against conventional ventilation on regional ventilation, gas exchange, and pulmonary mechanics in patients undergoing abdominal laparoscopic surgery.
Eligibility
Inclusion Criteria4
- Age > 18 years
- Scheduled for abdominal laparoscopy surgery
- At increased (i.e., intermediate or high) risk of postoperative pulmonary complications according to the "Assess Respiratory Risk in Surgical Patients in Catalonia" (ARISCAT) score (≥ 26 points)
- Signed written informed consent
Exclusion Criteria8
- Major previous lung surgery (e.g., lung resection)
- Severe chronic obstructive pulmonary disease and/or severe emphysema
- Increased intracranial pressure
- Contraindications for EIT (pacemakers, automatic external defibrillators, cases of chest trauma or recent chest surgery limiting EIT belt application)
- Presence of pneumothorax that is either undrained or newly occurred.
- Unstable hemodynamics with a mean arterial pressure < 60 mmHg and unresponsive to resuscitation measures, and/or heart rate < 60 bpm.
- Pregnancy.
- Severe neuromuscular disease.
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Interventions
The individualized high PEEP with RMs group commences with a PEEP of 5 cm H2O and undergo an RM followed by a decremental PEEP trial. Pressure-controlled ventilation mode is set with a respiratory rate of 16 breaths per minute and ΔP=15 (ΔP is calculated by subtracting PEEP from the plateau pressure (Pplat). In intervals of 5 breaths, PEEP is incrementally increased by 5 cm H2O, starting at 5 cm H2O and reaching up to 20 cm H2O. The decremental PEEP trial is immediately performed following the first RM, beginning at a PEEP of 20 cm H2O with a respiratory rate of 15 breaths per minute. Every 30 seconds, PEEP is decreased by increments of 2 cm H2O until it reaches a minimum of 6 cm H2O. This decremental PEEP trial is succeeded by a second RM, after which the individualized PEEP level will be established as determined by the decremental PEEP trial and sustained until the completion of ventilation.
Ventilation is set in volume-controlled mode with a tidal volume of 7 ml/kg predicted body weight (PBW), the respiratory rate is adjusted to target normocapnia (end-tidal carbon dioxide partial pressure between 35 and 45 mmH), an inspiratory to expiratory ratio of 1:2, and a PEEP of 5 cmH2O.
Locations(1)
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NCT06850844