Effectiveness of PEEP and Recruitment Maneuvers in Improving Oxygenation in Laparoscopic Hysterectomies: A Randomized Controlled Trial

Abstract

Rationale: To determine whether positive end-expiratory pressure (PEEP) with lung recruitment will benefit in improving oxygenation and in reduction of post-operative complications in patients undergoing gynecological laparoscopic surgeries in Trendelenburg position. Methods: Seventy-two patients, 36 in each arm, were recruited for single blind randomized controlled trial. Patients in intervention arm received a PEEP of 8 cm H2O and lung recruitment every 45 min and at the end of surgery. Patients in non-intervention arm (group N) received conventional ventilation with no PEEP and recruitment maneuver. Analysis was done on the basis of PaO2, intraoperative hemodynamics, and post-operative complications. Results: Intra-operative pH, pO2, and pCO2 values were 7.41 ± 0.03; 193.8 ± 13.4; and 38.6 ± 2.6 mmHg in group P, and 7.39 ± 0.72; 162.1 ± 5.3; and 38.8 ± 2 mmHg in group N. A significant increase in pO2 level was noted in the PEEP with recruitment group. Post-operative pH, pO2, and pCO2 values in group P were 7.33 ± 0.03; 87.5 ± 4; and 37.2 ± 3.1 mmHg, respectively, in group P and 7.32 ± 0.03, 87.8 ± 2.7; and 38.5 ± 2.6 mmHg in group N. No significant difference in the arterial blood gas (ABG) values was noted in both the groups in the post-operative period. We did not notice any significant hemodynamic variation in the intervention group (group P) checked 1 min, 3 min, and 5 after performing after recruitment maneuver (RM). Conclusion: PEEP with RM can be used to improve oxygenation in patients undergoing laparoscopic surgeries in Trendelenburg position. It has no effect in improving post-operative oxygenation.

Keywords

• lung recruitment maneuver
• oxygenation
• positive end-expiratory pressure
• trendelenburg position