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The aim of this study was to investigate whether individualized PEEP application improves respiratory function and reduces the incidence of postoperative pulmonary complications (PPCs) in patients undergoing laparoscopic total hysterectomy. Investigators hypothesized that individualized PEEP would improve pulmonary oxygenation and reduce the incidence of postoperative pulmonary complications.
The study included 113 patients who met the criteria and underwent elective laparoscopic total hysterectomy.
In the patients in the PEEPáµ¢ group, a recruitment maneuver was performed after intubation and after the Trendelenburg position was given. During this maneuver, the ventilator was switched to pressure-controlled mode, the I:E ratio was increased to 1:1, FiOâ‚‚ was increased to 80%, and the respiratory rate was set to 15/min. The PEEP level was increased to 20 cmHâ‚‚O with 5 cmHâ‚‚O increments every 5 respiratory cycles, and an airway opening pressure of 40 cmHâ‚‚O was obtained.
For optimal individual PEEP titration, the dynamic compliance values observed on the ventilator monitor were recorded when the PEEP reached 20 cmHâ‚‚O. The PEEP level was decreased by 2 cmHâ‚‚O every 3 respiratory cycles, and the PEEP level at which the highest compliance value was obtained was determined. The value 2 cmHâ‚‚O above this value was set as optimal PEEP, and this value was maintained throughout the surgery. The recruitment maneuver was repeated at specified time points during the surgical procedure and upon disconnection of the ventilator circuit.
Data collection was performed at several time points; before induction (T1), only hemodynamic data were recorded. Before pneumoperitoneum, 5 minutes after induction (T2) with the patient in the supine position, 20 minutes after the onset of pneumoperitoneum (T3) in the Trendelenburg position, and 60 minutes after the onset of pneumoperitoneum (T4) mechanical ventilation and hemodynamic parameters were recorded.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| individualized PEEP (PEEPi) | Experimental | In the patients in the PEEPáµ¢ group, a recruitment maneuver was performed after intubation and after the Trendelenburg position was given. The PEEP level was increased to 20 cmHâ‚‚O with 5 cmHâ‚‚O increments every five respiratory cycles, and an airway opening pressure of 40 cmHâ‚‚O was achieved. Dynamic compliance values observed on the ventilator monitor were recorded for optimal individual PEEP titration when PEEP reached 20 cmHâ‚‚O. The PEEP level was decreased by 2 cmHâ‚‚O every 3 respiratory cycles to determine the PEEP level at which the highest compliance value was achieved. 2 cmHâ‚‚O above this value was set as optimal PEEP, and this value was maintained throughout the surgery. |
|
| PEEP 5 | Active Comparator | Patients in the PEEP 5 group were applied a fixed 5 cmH2O PEEP, and no recruitment maneuver was performed. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dynamic compliance guided individualized positive end-expiratory pressure titration strategy | Procedure | For optimal individual PEEP titration, dynamic compliance values observed on the ventilator monitor were recorded when PEEP reached 20 cmHâ‚‚O. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pulmonary complications (PPC) | PPC included clinical conditions such as atelectasis, hypoxemia (PaOâ‚‚ < 8.0 kPa or SpOâ‚‚ < 90% on room air), pneumonia, acute respiratory distress syndrome (ARDS), pleural effusion, bronchospasm, pneumothorax, reintubation or need for non-invasive ventilation support. | within 7 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative respiratory mechanics parameter | Driving pressure | within intraoperative period |
| Respiratory mechanics parameter | Dynamic compliance |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Beyhan Guner, MD | Bakirkoy Dr. Sadi Konuk Research and Training Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bakirkoy Dr. Sadi Konuk Research and Training Hospital | Istanbul | Bakirkoy | 34147 | Turkey (Türkiye) |
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| standardized 5 PEEP | Procedure | Patients in the PEEP 5 group were applied a fixed 5 cmH2O PEEP and no recruitment maneuver was performed. |
|
| intraoperatively |
| Mechanic ventilation parameter | Pplatteau | during intraoperative period |
| Intensive care | Intensive care unit (ICU) admission | within 7 days after surgery |