Individualized PEEP, Postoperative Pulmonary Complications, Recruitment Maneuver, Total Hysterectomy
Conditions
Brief summary
The aim of this study was to investigate whether individualized PEEP application improves respiratory function and reduces the incidence of postoperative pulmonary complications (PPCs) in patients undergoing laparoscopic total hysterectomy. Investigators hypothesized that individualized PEEP would improve pulmonary oxygenation and reduce the incidence of postoperative pulmonary complications.
Detailed description
The study included 113 patients who met the criteria and underwent elective laparoscopic total hysterectomy. In the patients in the PEEPᵢ group, a recruitment maneuver was performed after intubation and after the Trendelenburg position was given. During this maneuver, the ventilator was switched to pressure-controlled mode, the I:E ratio was increased to 1:1, FiO₂ was increased to 80%, and the respiratory rate was set to 15/min. The PEEP level was increased to 20 cmH₂O with 5 cmH₂O increments every 5 respiratory cycles, and an airway opening pressure of 40 cmH₂O was obtained. For optimal individual PEEP titration, the dynamic compliance values observed on the ventilator monitor were recorded when the PEEP reached 20 cmH₂O. The PEEP level was decreased by 2 cmH₂O every 3 respiratory cycles, and the PEEP level at which the highest compliance value was obtained was determined. The value 2 cmH₂O above this value was set as optimal PEEP, and this value was maintained throughout the surgery. The recruitment maneuver was repeated at specified time points during the surgical procedure and upon disconnection of the ventilator circuit. Data collection was performed at several time points; before induction (T1), only hemodynamic data were recorded. Before pneumoperitoneum, 5 minutes after induction (T2) with the patient in the supine position, 20 minutes after the onset of pneumoperitoneum (T3) in the Trendelenburg position, and 60 minutes after the onset of pneumoperitoneum (T4) mechanical ventilation and hemodynamic parameters were recorded.
Interventions
PROCEDUREDynamic compliance guided individualized positive end-expiratory pressure titration strategy
For optimal individual PEEP titration, dynamic compliance values observed on the ventilator monitor were recorded when PEEP reached 20 cmH₂O.
PROCEDUREstandardized 5 PEEP
Patients in the PEEP 5 group were applied a fixed 5 cmH2O PEEP and no recruitment maneuver was performed.
Sponsors
Bakirkoy Dr. Sadi Konuk Research and Training Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Scheduled for elective laparoscopic total hysterectomy * ASA physical status I-III * BMI ≤30 kg/m² * Anticipated surgical duration \>2 hours
Exclusion criteria
* Pre-existing neuromuscular disorders * NYHA class III/IV heart failure * OSAS * Previous lung surgery * Severe pulmonary disease (FEV1 \<50% predicted)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pulmonary complications (PPC) | within 7 days after surgery | PPC included clinical conditions such as atelectasis, hypoxemia (PaO₂ \< 8.0 kPa or SpO₂ \< 90% on room air), pneumonia, acute respiratory distress syndrome (ARDS), pleural effusion, bronchospasm, pneumothorax, reintubation or need for non-invasive ventilation support. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative respiratory mechanics parameter | within intraoperative period | Driving pressure |
| Respiratory mechanics parameter | intraoperatively | Dynamic compliance |
| Mechanic ventilation parameter | during intraoperative period | Pplatteau |
| Intensive care | within 7 days after surgery | Intensive care unit (ICU) admission |
Countries
Turkey (Türkiye)
Outcome results
None listed