Assessment of the Effect of Individualized Protective Ventilation on Intraoperative Hemodynamics in Patients With Intact Lungs During Abdominal Surgery

Aim of the study was to evaluate the effect of recruiting maneuver (RM) and individualized positive end-expiratory pressure (PEEP) on the parameters of intraoperative hemodynamic in patients with healthy lungs during upper abdominal surgery. The group included 47 patients aged ≥18 years with an ARISCAT score of ≥26. Protective ventilation in volume-control mode was used intraoperative. Ventilation parameters: tidal volume 7 ml/ kg of ideal body weight; FiO2 – ≥40% to maintain SpO2 ≥93%; inhalation/exhalation ratio – 1: 2; respiratory rate – determined by the value of CO2 at the end of exhalation (EtCO2) 35-37 mm Hg, Pplat ≤17 cm Hg, Pdrive ≤13 cm Hg, the level of PEEP was selected individually. RM was performed immediately after orotracheal intubation and then if it was necessary. During the operation standard hemodynamic monitoring was performed and central hemodynamic parameters were studied. The cardiac output and cardiac index were assessment before and after the recruiting maneuver (RM), as well as every half hour during surgery, using an impedance cardiography module based on measurement of thoracic bioelectric impedance. The incidence of hypotension and bradycardia was established intraoperative. Statistical processing of the obtained data was performed using the programs “Microsoft Excel 2013” and “Statistica for Windows 6.0”. The results of the study showed that under conditions of protective mechanical ventilation using RM and positive end expiratory pressure, there is some circulatory depression, but the negative effect on intraoperative hemodynamic is negligible.