Impact of positive end-expiratory pressure with alveolar recruitment maneuver on respiratory and oxygenation parameters of patients during laparoscopic bariatric surgery

Abstract

- OBJECTIVE: Laparoscopic bar-iatric surgery is frequently associated with dis-turbances in respiratory mechanics. An alveo-lar recruitment maneuver (ARM) with positive end-expiratory pressure (PEEP) is a strategy to overcome such respiratory conditions. This study aimed to evaluate the effect of ARM+PEEP on intraoperative and postoperative respiratory and hemodynamic parameters of patients with laparoscopic bariatric surgery. PATIENTS AND METHODS: Patients who underwent laparoscopic bariatric surgery be-tween 2009 and 2016 were retrospectively eval-uated. The study sample was divided into four groups based on PEEP values and the preŞence of ARM: Group PEEP 5 (5 cm H2O PEEP only), Group PEEP 5/RM (5 cm H2O PEEP plus ARM), Group PEEP 10 (10 cm H2O PEEP only), Group PEEP 10/RM (10 cm H2O PEEP plus ARM). Pa-tients' demographic characteristics, ventilatory, respiratory, and oxygenation parameters were recorded. Oxygenation index (PaO2/FiO2) was the study's primary outcome. RESULTS: There were 156, 158, 299, and 210 patients in Groups PEEP 5, PEEF 5/RM, PEEP 10, and PEEP 10/RM, respectively. Tidal volume, driv-ing tidal volume/compliance, PaO2, PaO2/FiO2, and PaCO2 were significantly lower in Groups PEEP 5 and PEEP 5/RM, whereas SpO2 and FiO2 were significantly higher in Groups PEEP 5 and PEEP 5/RM (p<0.05). Patients in Group PEEP 5 had significantly higher end-tidal carbon diox-ide (EtCO2) values than those of other groups (p<0.001). Patients in Group PEEP 5/RM had sig-nificantly higher SpO2 values than those in Group PEEP 5 (p<0.001). Rate of postoperative atelecta-sis was significantly higher in Group PEEP 5/RM compared to the other groups (p=0.011). CONCLUSIONS: A PEEP level of at least 10 cm H2O with ARM improved intraoperative respi-ratory parameters and caused a significant re-duction in postoperative atelecTaşis.