Respiratory failure & ventilation
Individualized Positive End-expiratory Pressure Titration Strategies in Superobese Patients Undergoing Laparoscopic Surgery: Prospective and Nonrandomized Crossover Study
Authors' conclusion
In superobese patients undergoing laparoscopic surgery, individualized PEEPCompliance may provide a feasible compromise regarding end-expiratory transpulmonary pressures compared to PEEPEmpirical and PEEPTranspul, because PEEPCompliance with slightly negative end-expiratory transpulmonary pressures improved respiratory mechanics, lung volumes, and oxygenation while preserving cardiac output.
Study context
- Population
- Superobese patients (BMI 57.3 ± 6.4 kg/m²) undergoing laparoscopic bariatric surgerycrossover
- Participants
- 40 patients
- Exposure
- Individualized positive end-expiratory pressure (PEEP) vs fixed PEEP 8 cm H2O
- Outcome
- End-expiratory transpulmonary pressure at different surgical positioning
Methodological detailsnonrandomized
- Nonrandomized
Main finding
As reported in the abstract
End-expiratory transpulmonary pressure, PEEPCompliance vs PEEPEmpirical
| Group | Value | Supine with pneumoperitoneum | Beach chair with pneumoperitoneum |
|---|---|---|---|
| PEEPCompliance | mean −2.9 (SD 2.0) cm H2O | −2.9 ± 2.0 | −2.8 ± 2.2 |
| PEEPEmpirical | mean −10.6 (SD 2.6) cm H2O | −14.1 ± 3.7 | −9.2 ± 3.7 |
Value
PEEPCompliancemean −2.9 (SD 2.0) cm H2O
PEEPEmpiricalmean −10.6 (SD 2.6) cm H2O
Supine with pneumoperitoneum
PEEPCompliance−2.9 ± 2.0
PEEPEmpirical−14.1 ± 3.7
Beach chair with pneumoperitoneum
PEEPCompliance−2.8 ± 2.2
PEEPEmpirical−9.2 ± 3.7
- PEEPCompliance vs PEEPEmpirical: P < 0.001 — less negative with PEEPCompliance; P < 0.001 each position
- End-expiratory transpulmonary pressure lower with PEEPCompliance vs PEEPTranspul
- P < 0.001
Observational data: associations, not effects.
Secondary outcomes
| Outcome | PEEPEmpirical | PEEPCompliance | P value |
|---|---|---|---|
| Titrated PEEPPEEPCompliance vs PEEPEmpirical · P < 0.001 each position · main values: supine · mean, cm H2O | 8.0 (SD 0.0) | 17.2 (SD 2.4) | P < 0.001 |
| Supine with pneumoperitoneum | 8.0 ± 0.0 | 21.5 ± 2.5 | |
| Beach chair with pneumoperitoneum | 8.0 ± 0.0 | 15.8 ± 2.5 |
- Titrated PEEP — Titrated PEEP and lung volume lower with PEEPCompliance vs PEEPTranspul
- P < 0.001
Driving pressure and mechanical power
- Respiratory system and transpulmonary driving pressure and mechanical power normalized to compliance reduced with PEEPCompliance vs PEEPTranspul
Original publication
Individualized Positive End-expiratory Pressure Titration Strategies in Superobese Patients Undergoing Laparoscopic Surgery: Prospective and Nonrandomized Crossover Study. Anesthesiology. Published 24 May 2023. doi:10.
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