Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy


Haliloglu M., BİLGİLİ B. , Ozdemir M., UMUROĞLU T. , Bakan N.

MEDICAL PRINCIPLES AND PRACTICE, vol.26, no.6, pp.573-578, 2017 (Journal Indexed in SCI) identifier

  • Publication Type: Article / Article
  • Volume: 26 Issue: 6
  • Publication Date: 2017
  • Doi Number: 10.1159/000484693
  • Title of Journal : MEDICAL PRINCIPLES AND PRACTICE
  • Page Numbers: pp.573-578
  • Keywords: Pneumoperitoneum, Steep Trendelenburg, Low tidal volume, Positive end-expiratory pressure, Pulmonary function, Robot-assisted surgery, STEEP TRENDELENBURG POSITION, LUNG-PROTECTIVE VENTILATION, CONTROLLED-TRIAL, SURGERY, PNEUMOPERITONEUM, COMPLICATIONS, OUTCOMES, UROLOGY

Abstract

Objective: The aim was to compare the effects of low tidal volume (V-T) and moderate positive end-expiratory pressure (PEEP) with high V-T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V-T-PEEP and high V-T-ZEEP groups. The patients were ventilated with a V-T of 6 mL/kg and 8 cm H2O PEEP in the low V-T-PEEP group and a V-T of 10 mL/kg and 0 cm H2O PEEP in the high V-T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V-T-PEEP group than in the high V-T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V-T-PEEP group than in the high V-T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V-T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V-T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V-T of 6 mL/kg and 8 cm H2O PEEP than in patients ventilated with a V-T of 10 mL/kg and ZEEP. (C) 2017 The Author(s) Published by S. Karger AG, Basel