Key result
Semi-lateral lung recruitment reduces maximal systolic pressure drop by ~33% versus the supine position.
Why the study?
The physiological benefits of performing lung recruitment maneuver in the semi-lateral position compared to the supine position after laparoscopic surgery were unclear.
Does performing lung recruitment maneuver in a semi-lateral position reduce the maximal decrease in systolic arterial pressure during LRM in adult male patients undergoing laparoscopic prostatectomy?
RCT (n=79)
Single-blind
1:1 using computer-generated numbers
No
Does performing lung recruitment maneuver in a semi-lateral position reduce the maximal decrease in systolic arterial pressure during LRM in adult male patients undergoing laparoscopic prostatectomy?
Absolute Event Rate: -18.6% vs -27.6%
p-value: p=0.001
Performing lung recruitment in a semi-lateral position after laparoscopic surgery protects against hemodynamic deterioration and improves arterial oxygenation compared to the supine position.
Semi-lateral positioning may lessen hypotension during recruitment; leaves open whether this improves outcomes in ventilated patients.
We evaluated the physiological benefits of performing lung recruitment maneuver (LRM) in the semi-lateral position compared in the supine position. Seventy-nine patients undergoing laparoscopic prostatectomy were randomly assigned to either the supine or semi-lateral group according to body position during the LRM. At the end of surgery, LRM (35 cmH2O for 20 s) was performed twice in the assigned posture. The primary outcome was the maximal decrease in systolic arterial pressure during LRM. Secondary outcomes were changes in PaO2/FiO2 and the regional lung volume distribution after LRM. The decrease in systolic arterial pressure during the LRM was significantly higher in the supine group than in the semi-lateral group (mean ± standard deviation, [−] 27.6 ± 14.6% vs. [−] 18.6 ± 9.9%, P = 0.001). Improvement in PaO2/FiO2 ratio after the LRM was evident in both groups but was more prominent in the semi-lateral group than in the supine group (median [interquartile range], 39.3% [20.2, 63.6] vs. 18.2% [8.4, 29.2], P = 0.001). Among the horizontal lung divisions, regional lung volume in the most dependent portion (the dorsal division) was significantly increased after the LRM only in the semi-lateral group (P = 0.024). Performing lung recruitment in a semi-lateral position protected against hemodynamic deterioration during the LRM and increased regional lung ventilation in the dependent portion of the lung, leading to an improvement in arterial oxygenation after laparoscopic procedures. Trial registration Clinical Research Information Service ( https://cris.nih.go.kr/ ). Identifier: KCT0003756.
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Oh et al. (2022) conducted an RCT in Robot-assisted laparoscopic radical prostatectomy (n=79). Lung recruitment maneuver in the semi-lateral position vs. Lung recruitment maneuver in the supine position was evaluated on Maximal decrease in systolic arterial pressure during lung recruitment maneuver (p=0.001). Performing a lung recruitment maneuver in the semi-lateral position significantly attenuated the maximal decrease in systolic arterial pressure compared to the supine position (-18.6% vs -27.6%, p=0.001).
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