Key result
Transesophageal ultrasound-guided PEEP titration increases cerebral oxygen saturation and cardiac output versus fixed PEEP.
Why the study?
The effect of optimal pulmonary compliance titration of PEEP on cardiac function and hemodynamics in patients undergoing laparoscopic surgery was unclear.
Does optimal pulmonary compliance titration of PEEP guided by ONLM-based transesophageal ultrasound improve cardiac function and hemodynamics in patients undergoing laparoscopic surgery?
RCT (n=120)
Does optimal pulmonary compliance titration of PEEP guided by ONLM-based transesophageal ultrasound improve cardiac function and hemodynamics in patients undergoing laparoscopic surgery?
p-value: p=<0.05
Optimal pulmonary compliance titration of PEEP guided by an improved transesophageal ultrasound algorithm better maintains arterial acid-base balance and increases cerebral oxygen saturation and cardiac output during laparoscopic surgery.
Supports ONLM-based TEE-guided PEEP titration in laparoscopic surgery; extends RCT evidence for dynamic compliance optimization.
The aim of this study was to analyze the effect of optimal pulmonary compliance titration of PEEP regimen on cardiac function and hemodynamics in patients undergoing laparoscopic surgery. 120 patients undergoing elective laparoscopic radical resection of colorectal cancer were included as the study subjects and randomly divided into the experimental group ( n = 60 ) and the control group ( n = 60 ). The control group had a fixed positive end-expiratory pressure PEEP = 5 cmH2O. The experimental group had transesophageal ultrasound monitoring through on an improved noise reduction algorithm (ONLM) based on nonlocal mean filtering (NLM) according to optimal pulmonary compliance titration of PEEP. There was significant difference in cerebral oxygen saturation and blood glucose level at T4-T6 between the experimental group and the control group ( P < 0.05 ); the signal-to-noise ratio (SNR), figure of merit (FOM), and structural similarity (SSIM) of ONLM algorithm were significantly higher than those of NLM algorithm and Bayes Shrink denoising algorithm, and the differences were statistically significant ( P < 0.05 ); there was significant difference in stroke volume (SV) and cardiac output (CO) at T4-T6 between the experimental group and the control group ( P < 0.05 ); there was significant difference in pH, partial pressure of carbon dioxide (PCO2), and PO2 at T4-T6 between the experimental group and the control group ( P < 0.05 ); pH was higher, and PCO2 and PO2 were lower in the experimental group. The results showed that transesophageal ultrasound based on the ONLM algorithm can accurately assess cardiac function and hemodynamics in patients undergoing laparoscopic surgery. In addition, optimal pulmonary compliance titration of PEEP could better maintain arterial acid-base balance during perioperative period and increase cerebral oxygen saturation and CO, but this strategy had no significant effect on hemodynamics.
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Wang et al. (2022) conducted an RCT in Colorectal cancer undergoing elective laparoscopic radical resection (n=120). Optimal pulmonary compliance titration of PEEP with ONLM-based transesophageal ultrasound monitoring vs. Fixed PEEP of 5 cmH2O was evaluated on Cardiac function and hemodynamics (cerebral oxygen saturation, blood glucose, SV, CO, pH, PCO2, PO2) (p=<0.05). Optimal pulmonary compliance titration of PEEP with ONLM-based transesophageal ultrasound increased cerebral oxygen saturation and cardiac output compared to fixed PEEP (P<0.05).
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