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The goal of this prospective intervention study is to determine whether individualized positive end expiratory pressure (PEEP) titration targeting the minimum Driving pressure (ΔP) during LGS operation improves intraoperative pulmonary dynamic compliance (Cdyn), oxygenation, post operative pulmonary complication (PPCS) Participants will be assigned to two group (incremental - fixed )peep group Researchers will compare the two group to see if peep titration improve lung compliance, lung mechanics intraopertive and PPCS
Obesity (BMI \ge 30 kg/m^2) significantly increases the risk of atelectasis and respiratory dysfunction under anesthesia. During Laparoscopic Sleeve Gastrectomy (LSG), the combination of pneumoperitoneum and the Trendelenburg position further impairs lung compliance. Standard lung-protective strategies often use a fixed PEEP, which may be insufficient for obese patients or cause hemodynamic instability if set too high.
Fixed PEEP (usually 5 cmH_2O) does not account for individual variations in chest wall mechanics during laparoscopy.
This prospective, randomized, double-blind study involving 46 patients (20-60 years old, BMI 35-40 kg/m^2).
The Intervention
Key Outcomes
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| incremental peep | Active Comparator | after the pneumo- peritoneum- anti Trendelenburg position is established and RM is performed. PEEP will be gradually increased by 1 cmH2O starting from the lowest PEEP allowed by the anesthesia machine (3 cmH2O) to 12 cmH2O, and each PEEP level will be maintained for 10 respiratory cycles and the driving pressure values will be recorded. When driving pressure increased with increasing PEEP, downward PEEP titration will be per- formed until the minimum driving pressure appears. this optimal individualized PEEP will be maintained throughout the procedure. |
|
| fixed peep | No Intervention | Fixed PEEP = 5 cmHâ‚‚O through surgery |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| incremental peep | Other | PEEP will be gradually increased by 1 cmH2O starting from the lowest PEEP allowed by the anesthesia machine (3 cmH2O) to 12 cmH2O, and each PEEP level will be maintained for 10 respiratory cycles and the driving pressure values will be recorded. When driving pressure increased with increasing PEEP, downward PEEP titration will be per- formed until the minimum driving pressure appears |
| Measure | Description | Time Frame |
|---|---|---|
| dynamic pulmonary compliance | Measurement of the lung's ability to stretch and expand during mechanical ventilation, calculated 10 minutes after the cessation of pneumoperitoneum. This measures the impact of individualized PEEP versus fixed PEEP on respiratory mechanics after the main surgical stressor is removed | Recorded at T3 (10 minutes after pneumoperitoneum cessation). |
| Measure | Description | Time Frame |
|---|---|---|
| Oxygenation Ratio (PaO_2/FiO_2) | Assessed via arterial blood gas analysis to evaluate gas exchange efficiency. | Recorded at T0(10 minutes after tracheal intubation), , T2(1 hour after pneumoperitoneum establishment), and T4 (15 minutes after extubation). |
| Driving Pressure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eman G Radwan, master | Contact | +201278555771 | eman_gamal1@hotmail.com | |
| Samaa A Rashwan, Professor | Contact | +201270159125 | samaarashwan1971@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Beni-Suef University Hospital | Banī Suwayf | Beni Suweif Governorate | 62511 | Egypt |
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This is a prospective, randomized, double-blinded, parallel-group study. Patients are randomly assigned in a 1:1 ratio to either the intervention or control group using a computer-generated sequence.
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Participants will be randomly assigned to either "Incremental" or "Fixed" in 1:1 ratio according to computer generated random number sequence prepared by an independent statistician who had no involvement in participant recruitment.
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Calculated as Plateau pressure minus PEEP. |
| Recorded at T0 (10 minutes after intubation), T1 (10 minutes after pneumoperitoneum), T2 (1 hour after pneumoperitoneum), and T3 (10 minutes after pneumoperitoneum cessation). |
| Postoperative Pulmonary Complications (PPCs) | Incidence of hypoxia, bronchospasm, or chest infections (cough, fever, expectoration). | Within 48 hours postoperatively. |