Bhardwaj Neerja, Sarkar Soumya, Yaddanapudi Sandhya, Jain Divya
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Anesthesiology, and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Saudi J Anaesth. 2022 Oct-Dec;16(4):430-436. doi: 10.4103/sja.sja_445_22. Epub 2022 Sep 3.
Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10-cm HO of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP.
After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2-10 years, undergoing LAP were randomized to receive PEEP of 5- or 10-cm HO during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO, and PaCO were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O) were calculated at the above-mentioned time points. Data were analyzed using Student's -test and repeated measures ANOVA with Bonferroni correction.
The oxygenation index and D(A-a)O decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant ( = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant ( = 0.001). There were no significant changes in the hemodynamic parameters in the two groups.
Use of 10-cm HO PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.
呼气末正压通气（PEEP）用于减轻腹腔镜（LAP）手术期间气腹导致的呼吸参数变化。由于儿童LAP手术中理想的PEEP水平尚不清楚，本研究比较了5 cmH₂O和10 cmH₂O的PEEP对小儿LAP手术期间氧合、通气和血流动力学参数的影响。
获得机构伦理委员会批准并取得家长书面知情同意后，将30例年龄2至10岁、接受LAP手术的美国麻醉医师协会（ASA）I级和II级儿童随机分为两组，在气腹期间分别接受5 cmH₂O或10 cmH₂O的PEEP。在气管插管后2分钟、气腹后2分钟和1小时以及气腹放气后测量基线血流动力学和通气参数、动脉血氧分压（PaO₂）和动脉血二氧化碳分压（PaCO₂）。在上述时间点计算氧合指数、动态顺应性和肺泡-动脉氧分压差（D（A-a）O₂）。数据采用Student's t检验和重复测量方差分析，并进行Bonferroni校正。
气腹后，PEEP 5组的氧合指数和D（A-a）O₂降低，PEEP 10组升高，两组间差异有统计学意义（P = 0.001）。气腹后，PEEP 5组的动态顺应性降低，PEEP 10组升高或保持不变，两组间差异有统计学意义（P = 0.001）。两组血流动力学参数无显著变化。
儿童气腹期间使用10 cmH₂O的PEEP可改善通气和氧合，且无明显血流动力学变化。
