Respiratory failure & ventilation
Regional Alveolar Damage Despite Lung Protective Ventilation Settings During Robotic-Assisted Laparoscopic Surgery
Authors' conclusion
In this focused biomechanical study, we found molecular evidence for alveolar-capillary damage in the dependent apical lobes, consistent with localized atelectrauma.
Study context
- Population
- Adults without lung disease undergoing robotic-assisted laparoscopic surgery (steep Trendelenburg) with LPV, academic hospital, US8 M/7F
- Participants
- 15 adults
- Exposure
- Apical vs anteromedial bronchoalveolar lavages (BAL), after intubation vs before extubation
- Outcome
- Lung injury markers in BAL (total protein, proteomics, lipidomics, leukocyte counts) and lung mechanics
- Follow-up
- After intubation vs before extubation
Methodological detailssingle-center, biomechanical
- Single-center
- Biomechanical
Main finding
As reported in the abstract
BAL markers after surgery
- Increase in total protein, apical BAL (median [IQR])
- 131 [27-193] µg/mL
- Increase in fibulin-1, apical BAL
- 2.1 [1.6-4.0] fold
- Increase in microfibril-associated glycoprotein-4, apical BAL
- 2.2 [1.3-4.0] fold
- Increase in prothrombin, apical BAL
- 1.7 [1.3-4.8] fold
- Increase in plasminogen, apical BAL
- 3.2 [1.9-4.5] fold
- Apical BAL increases, adjusted P for all
- adj. P < .001
- No increases in anteromedial BAL
- adj. P > .05
Observational data: associations, not effects.
Further findings
Lung mechanics
- Tidal volume, mL/kg ideal body weight (mean ± SD)
- 7.0 ± 0.8
- PEEP, cm H2O (mean ± SD)
- 8.7 ± 3.4
- Elevated respiratory elastance and driving pressures, negative end-expiratory transpulmonary pressures despite standard LPV
Percent leukocyte composition
- No differences among lavages
- P > 0.287 for all cell types
Phosphatidylglycerol abundance, apical BAL after surgery
- Increased in unadjusted analyses
- 5.8 [1.9-7.9] %, P = .021
- No changes in phospholipid abundance in adjusted analysis
Correlation of apical BAL total protein increase with dissipated mechanical power
- Positive correlation
- r2 = 0.434, P = .014
Original publication
Regional Alveolar Damage Despite Lung Protective Ventilation Settings During Robotic-Assisted Laparoscopic Surgery. Anesth Analg. Published 1 June 2026. doi:10.
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