Respiratory failure & ventilation
Minimizing Lung Injury During Laparoscopy in Head-Down Tilt: A Physiological Cohort Study
Authors' conclusion
Higher PEEP levels during laparoscopy in the head-down position facilitate lung-protective ventilation. Atelectasis and lung stress are reduced in the absence of global alveolar hyperinflation.
Study context
- Population
- Nonobese patients scheduled for laparoscopy in the Trendelenburg position, single tertiary Belgian university hospital
- Participants
- 23 repeated measures
- Exposure
- Decremental positive end-expiratory pressure (PEEP) 15 vs 10 vs 5 cm H 2 O
- Outcome
- Atelectasis, lung stress and hyperinflation by PEEP level
Methodological detailsopen-label, repeated-measures, interventional, single-centre
- Open-label
- Repeated-measures
- Interventional
- Single-centre
Main finding
As reported in the abstract
| Group | Value | Lung ultrasound score | End-expiratory transpulmonary pressure (cm H 2 O) | PaO2/FiO2 (mm Hg) | Dynamic compliance (mL/cm H 2 O) | Driving pressure (cm H 2 O) | Alveolar dead space fraction (%) |
|---|---|---|---|---|---|---|---|
| 15 | median 11 (IQR 0–22) % | 11 (0-22) | 0.9 (−0.6 to 1.7) | 471 (435-538) | 32 (26-36) | 8.2 (7.5-9.5) | 10 (9-12) |
| 10 | median 27 (IQR 11–39) % | 27 (11-39) | −0.3 (−2.0 to 0.7) | 458 (410-537) | 30 (25-34) | 9.3 (8.5-11.1) | 10 (9-12) |
| 5 | median 53 (IQR 42–61) % | 53 (42-61) | −1.9 (−4.6 to −0.9) | 431 (358-492) | 27 (22-30) | 11.0 (10.3-12.2) | 9 (8-12) |
Value
15median 11 (IQR 0–22) %
10median 27 (IQR 11–39) %
5median 53 (IQR 42–61) %
Lung ultrasound score
1511 (0-22)
1027 (11-39)
553 (42-61)
End-expiratory transpulmonary pressure (cm H 2 O)
150.9 (−0.6 to 1.7)
10−0.3 (−2.0 to 0.7)
5−1.9 (−4.6 to −0.9)
PaO2/FiO2 (mm Hg)
15471 (435-538)
10458 (410-537)
5431 (358-492)
Dynamic compliance (mL/cm H 2 O)
1532 (26-36)
1030 (25-34)
527 (22-30)
Driving pressure (cm H 2 O)
158.2 (7.5-9.5)
109.3 (8.5-11.1)
511.0 (10.3-12.2)
Alveolar dead space fraction (%)
1510 (9-12)
1010 (9-12)
59 (8-12)
- Lung ultrasound score across PEEP levels
- P < 0.001
- End-expiratory transpulmonary pressure across PEEP levels
- P < 0.001
- PaO2/FiO2 across PEEP levels
- P < 0.001
- Dynamic compliance across PEEP levels
- P < 0.001
- Driving pressure across PEEP levels
- P < 0.001
- Alveolar dead space fraction across PEEP levels
- P = 0.23
Observational data: associations, not effects.
Further findings
Lung ultrasound score, apical vs basal regions
- Similar between apical and basal regions at each PEEP level (15, 10, 5)
- P = 0.76, .37, and .76
Original publication
Minimizing Lung Injury During Laparoscopy in Head-Down Tilt: A Physiological Cohort Study. Anesth Analg. Published 14 December 2022. doi:10.
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