Key result
A descending pattern of PEEP significantly improved arterial oxygenation (PaO2/FiO2 470±10) compared to ascending (418±19) or steady PEEP (422±12) in obese patients under general anesthesia.
Why the study?
With obese patients increasing among the surgical population, the study aimed to identify the most beneficial level and pattern of PEEP during mechanical ventilation under general anesthesia in the beach-chair position.
Does a descending pattern of PEEP improve arterial oxygenation compared to ascending or steady PEEP in obese patients under general anesthesia in the beach-chair position?
RCT (n=45)
Does a descending pattern of PEEP improve arterial oxygenation compared to ascending or steady PEEP in obese patients under general anesthesia in the beach-chair position?
Absolute Event Rate: 470% vs 418%
A descending pattern of PEEP (10, 7, 5 cmH2O) improves arterial oxygenation more effectively than ascending or steady PEEP in obese patients undergoing general anesthesia in the beach-chair position.
Optimal PEEP patterns for oxygenation in obese beach-chair anesthesia remain uncertain; larger trials needed before practice change.
Background Obese patients are increasing among surgical population. Aim To detect the most beneficial level and pattern of positive end-expiratory pressure (PEEP) to mechanically ventilate obese patients under general anesthesia in beach-chair position. Patients and methods A prospective randomized study was conducted that included 45 ASA II patients (21–65 years) of both sexes who were randomized into three groups: group I ( n =15), ascending PEEP (5, 7, 10 cmH 2 O); group II ( n =15), steady PEEP5; and group III ( n =15), descending PEEP (10, 7, 5 cmH 2 O). Results Arterial oxygenation (PaO 2 /FiO 2 ) was significantly higher in group III at PEEP 10 (470±10) than groups I (418±19) and II (422±12) at that time. At PEEP 10 , PaO 2 /FiO 2 was significantly higher in group III (470±10) than group I (448±11). After 40 min, it was significantly higher in group III (456±66) than groups I (432±12) and II (428±14). After 60 min, it was significantly lower at group II (426±12) than groups I (448±11) and III (444±24). Postoperatively, it was significantly higher in group III (460±24) than group I (436±11) and II (415±61). Peak airway pressure was significantly higher with PEEP 10 in group I (34.6±2.2) than groups II (26.5±3.8) and III (27.7±3.2). It was also significantly higher with PEEP 10 in group III (34.1±2.1) than groups I (26.7±3.7) and II (27.3±3.8). Plateau pressure was significantly higher with PEEP 10 in group I (23.8±2.1) than groups II (15.1±3) and III (15.2±2.6). It was also significantly higher with PEEP 10 in group III (23.3±1.7) than groups I (15.3±2.9) and II (15.9±2.6). Driving pressure was significantly higher in group III (13.3±1.7) than groups I (10.3±2.9) and II (10.9±2.6) with PEEP 10 . It was also significantly higher in group I with PEEP 10 (13.8±2.1) than groups II (10.1±3) and III (10.2±2.6). Conclusion Descending pattern of PEEP (10, 7, and 5) improves oxygenation more effectively than ascending pattern of PEEP (5, 7, and 10) or steady pattern (PEEP 5 ) for mechanical ventilation of obese patients under general anesthesia in beach-chair position.
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Salwa H. Waly (2021) conducted an RCT in Obese patients under general anesthesia in beach-chair position (n=45). Descending pattern of PEEP vs. Ascending PEEP (5, 7, 10 cmH2O) or steady PEEP (5 cmH2O) was evaluated on Arterial oxygenation (PaO2/FiO2). A descending pattern of PEEP significantly improved arterial oxygenation (PaO2/FiO2 470±10) compared to ascending (418±19) or steady PEEP (422±12) in obese patients under general anesthesia.
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