Buonanno Pasquale, Marra Annachiara, Iacovazzo Carmine, Merola Raffaele, De Siena Andrea Uriel, Servillo Giuseppe, Vargas Maria
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, 80100, Naples, Italy.
Sci Rep. 2023 Feb 16;13(1):2753. doi: 10.1038/s41598-023-29860-x.
Electrical impedance tomography (EIT) reconstructs functional lung images and evaluates the variations of impedance during the breathing cycle. The aim of this study was to evaluate the effect of protective mechanical ventilation on ventilation distributions recorded by the EIT during elective robotic-assisted laparoscopy surgery with steep Trendelenburg position. This prospective, randomized single center study included patients with healthy lungs undergoing elective robot-assisted laparoscopic urological surgery in general anesthesia. Patients were randomly assigned to either protective lung ventilation or conventional ventilation. In the protective ventilation group, tidal volume (TV) was set at 6 ml/Kg predicted body weight (PBW), with PEEP 6 cmHO, and recruitment maneuvers (RM) as needed. In the conventional ventilation group, TV was set at 9 ml/Kg PBW, with PEEP 2 cmHO and RM only as needed. Ventilation distribution was assessed using an EIT device. This study included 40 patients in the functional image analysis. Significant differences were found in ventilation distribution in the region of interest (p < 0.05). Driving pressure was significantly lower in protective ventilation group (p < 0.05). Peak and plateau pressures were not different between the groups while statical significance was found in tidal volume and respiratory rate. EIT may be a valuable tool for monitoring lung function during general anesthesia. During elective robotic-assisted laparoscopy surgery with steep Trendelenburg position, protective mechanical ventilation may have a more homogenous distribution of intraoperative and postoperative ventilation. Larger sample size and long-term evaluation are needed in future studies to assess the benefit of EIT monitoring in operation room.Clinical trial registration ClinicalTrials.gov Identifier: NCT04194177 registered at 11th December 2019.
电阻抗断层成像（EIT）可重建肺功能图像并评估呼吸周期中阻抗的变化。本研究的目的是评估在择期机器人辅助腹腔镜手术中采用头低脚高位时，保护性机械通气对EIT记录的通气分布的影响。这项前瞻性、随机单中心研究纳入了在全身麻醉下接受择期机器人辅助腹腔镜泌尿外科手术的肺部健康患者。患者被随机分为保护性肺通气组或传统通气组。在保护性通气组中，潮气量（TV）设定为6 ml/公斤预测体重（PBW），呼气末正压（PEEP）为6 cmH₂O，并根据需要进行肺复张手法（RM）。在传统通气组中，TV设定为9 ml/公斤PBW，PEEP为2 cmH₂O，仅在需要时进行RM。使用EIT设备评估通气分布。本研究纳入40例患者进行功能图像分析。在感兴趣区域的通气分布中发现了显著差异（p < 0.05）。保护性通气组的驱动压显著更低（p < 0.05）。两组之间的峰压和平台压无差异，而在潮气量和呼吸频率方面发现了统计学意义。EIT可能是全身麻醉期间监测肺功能的有价值工具。在采用头低脚高位的择期机器人辅助腹腔镜手术期间，保护性机械通气可能使术中和术后通气分布更均匀。未来研究需要更大样本量和长期评估，以评估EIT监测在手术室中的益处。临床试验注册ClinicalTrials.gov标识符：NCT04194177，于2019年12月11日注册。
