Key result
PEEP with lung recruitment increased intra-operative pO2 during laparoscopic hysterectomies, but did not improve post-operative oxygenation.
Why the study?
It was unclear whether positive end-expiratory pressure with lung recruitment improves oxygenation and reduces post-operative complications during gynecological laparoscopic surgeries in Trendelenburg position.
Does PEEP with lung recruitment improve oxygenation in patients undergoing gynecological laparoscopic surgeries in Trendelenburg position?
RCT (n=72)
Single-blind
randomized
Does PEEP with lung recruitment improve oxygenation in patients undergoing gynecological laparoscopic surgeries in Trendelenburg position?
Answers are grounded in this paper and cite their sources.
PEEP with recruitment maneuvers improves intra-operative oxygenation during laparoscopic surgeries in the Trendelenburg position but does not affect post-operative oxygenation.
A BSTRACT Rationale: To determine whether positive end-expiratory pressure (PEEP) with lung recruitment will benefit in improving oxygenation and in reduction of post-operative complications in patients undergoing gynecological laparoscopic surgeries in Trendelenburg position. Methods: Seventy-two patients, 36 in each arm, were recruited for single blind randomized controlled trial. Patients in intervention arm received a PEEP of 8 cm H 2 O and lung recruitment every 45 min and at the end of surgery. Patients in non-intervention arm (group N) received conventional ventilation with no PEEP and recruitment maneuver. Analysis was done on the basis of PaO 2 , intraoperative hemodynamics, and post-operative complications. Results: Intra-operative pH, pO 2 , and pCO 2 values were 7.41 ± 0.03; 193.8 ± 13.4; and 38.6 ± 2.6 mmHg in group P, and 7.39 ± 0.72; 162.1 ± 5.3; and 38.8 ± 2 mmHg in group N. A significant increase in pO 2 level was noted in the PEEP with recruitment group. Post-operative pH, pO 2 , and pCO 2 values in group P were 7.33 ± 0.03; 87.5 ± 4; and 37.2 ± 3.1 mmHg, respectively, in group P and 7.32 ± 0.03, 87.8 ± 2.7; and 38.5 ± 2.6 mmHg in group N. No significant difference in the arterial blood gas (ABG) values was noted in both the groups in the post-operative period. We did not notice any significant hemodynamic variation in the intervention group (group P) checked 1 min, 3 min, and 5 after performing after recruitment maneuver (RM). Conclusion: PEEP with RM can be used to improve oxygenation in patients undergoing laparoscopic surgeries in Trendelenburg position. It has no effect in improving post-operative oxygenation.
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Gayathri et al. (2023) conducted an RCT in Gynecological laparoscopic surgeries in Trendelenburg position (n=72). Positive end-expiratory pressure (PEEP) with lung recruitment vs. Conventional ventilation with no PEEP and recruitment maneuver was evaluated on Intra-operative pO2. PEEP with lung recruitment increased intra-operative pO2 during laparoscopic hysterectomies, but did not improve post-operative oxygenation.
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