Effect of Individualized Positive End-Expiratory Pressure in Obese Patients After Laparoscopic Hysterectomy
LIU Hui
KONG Erliang
WANG Xiuhuan
ZHANG Yang
LI Yuheng
WANG Jianxin
FENG Xudong
Abstract：Objective To investigate the effect of driven pressure-directed positive end-expiratory pressure(PEEP)in obese patients during laparoscopic adnexectomy.Methods A total of 60 obese patients who underwent laparoscopic hysterectomy in the 988 Hospital of the People's Liberation Army Joint Logistic Support Force from August 2021 to August 2022 were selected and divided into fixed PEEP group and driven pressure oriented individualized PEEP group according to random number table method,with 30 cases in each group.In the fixed PEEP group,a PEEP of 5 cmH2O was set after endotracheal intubation and continued until the end of surgery.In the driven pressure oriented individualized PEEP group,pulmonary reexpansion was performed at 3 moments,after tracheal intubation,established in Trendelenburg position and pneumoperitoneum closure,a PEEP of 20 cmH2O was set,and the PEEP decreased to 4 cmH2O at an interval of 2 cmH2O after every 10 breathing cycles,the PEEP corresponding to the lowest driving pressure in the titration process was the best PEEP,and the optimal PEEP was maintained to the next time period.Driving pressure and oxygenation index(OI)were respectively recorded at three individualized PEEP setting after 5 minutes(T2,T3,T4).Serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-12(IL-12),Clara cell secretory protein-16(CC16)levels were determinated before anesthesia(T1)and 24 hours after anesthesia(T6).Lung ultrasound score(LUS)at T,and immediately after tracheal catheter withdrawal(T5)were compared.Results Compared with T2,the driving pressure at T3 was increased in both groups(P＜0.05).Compared with T3,the driving pressure of T4 decreased(P＜0.05).Compared with the fixed PEEP group,the OI of the driven pressure oriented individualized PEEP group increased and the driving pressure decreased at T2-T4(P＜0.05).Compared with T1,the LUS of the two groups was increased at T5,compared with the fixed PEEP group,the LUS of the driven pressure oriented individualized PEEP group was decreased at T5.The serum TNF-α,IL-6,IL-12 and CC16 levels of the two groups were increased at T6,and the driven pressure oriented individualized PEEP group were lower than those of the fixed PEEP group(P＜0.05).Conclusion Driven pressure-directed individualized PEEP ventilation can improve the dynamic lung compliance on the perioperative period of laparoscopic adnexectomy in obese patients,improve pulmonary oxygenation function,reduce the release of inflammatory mediators,and reduce drive pressure and postoperative LUS.
Keywords：drive pressureindividualized positive end-expiratory pressurecorpulentlaparoscopic surgerylung function
Publication Date：2023-12-31
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：5( 4437-4441 )