Why the study?
Does an alveolar recruitment strategy and high PEEP affect hemodynamics in morbidly obese intravascular volume-loaded patients undergoing laparoscopic surgery?
Does an alveolar recruitment strategy and high PEEP affect hemodynamics in morbidly obese intravascular volume-loaded patients undergoing laparoscopic surgery?
Alveolar recruitment and high PEEP can be safely applied without significant hemodynamic compromise in morbidly obese, volume-loaded patients during laparoscopic surgery.
May support safe use of recruitment and high PEEP in this population; leaves open confirmation in randomized trials.
We evaluated the effect of the alveolar recruitment strategy and high positive end-expiratory pressure (PEEP) on hemodynamics in 20 morbidly obese (body mass index 50 +/- 9 kg/m2), intravascular volume-loaded patients undergoing laparoscopic surgery. The alveolar recruitment strategy was sequentially performed with and without capnoperitoneum and consisted of an upward PEEP trial, recruitment with 50-60 cm H2O of plateau pressure for 10 breaths, and a downward PEEP trial. Recruitment and high PEEP did not cause significant disturbances in any hemodynamic variable measured by systemic and pulmonary artery catheters. Transesophageal echocardiography revealed no differences in end-diastolic areas or evidence of segmental abnormalities in wall motion.
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Böhm et al. (2009) studied this question.
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