Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

• Published in: Medical principles and practice Vol. 26; no. 6; pp. 573 - 578
• Main Authors: Haliloglu, Murat, Bilgili, Beliz, Ozdemir, Mehtap, Umuroglu, Tumay, Bakan, Nurten
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2017
• Subjects: Abdomen; Abdominal surgery; Anesthesia; Anesthesiology; Hospitals; Laparoscopy; Original Paper; Pain; Patients; Prostate cancer; Robots; Urological surgery; Urology; Ventilators; Istanbul Turkey; Turkey; Steep Trendelenburg; Low tidal volume; Positive end-expiratory pressure; Robot-assisted surgery; Pulmonary function; Pneumoperitoneum
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000484693

Objective: The aim was to compare the effects of low tidal volume (V T ) and moderate positive end-expiratory pressure (PEEP) with high V T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V T -PEEP and high V T -ZEEP groups. The patients were ventilated with a V T of 6 mL/kg and 8 cm H 2 O PEEP in the low V T -PEEP group and a V T of 10 mL/kg and 0 cm H 2 O PEEP in the high V T -ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V T -PEEP group than in the high V T -ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V T -PEEP group than in the high V T -ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V T -PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V T -ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V T of 6 mL/kg and 8 cm H 2 O PEEP than in patients ventilated with a V T of 10 mL/kg and ZEEP.