Shaji Unnikannan, Jain Gaurav, Tripathy Debendra Kumar, Kumar Navin, Chowdhury Nilotpal
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep;40(3):516-522. doi: 10.4103/joacp.joacp_45_23. Epub 2024 Mar 28.
Pneumoperitoneum creation for laparoscopic surgery increases the intraabdominal pressure and causes alveolar atelectasis. We investigated the influence of an increase in intra-abdominal pressure (IAP) on ventilatory mechanical power (MP) delivery during pneumoperitoneum creation for laparoscopic cholecystectomy.
In a prospective cohort design, we enrolled 42 patients undergoing laparoscopic cholecystectomy. During pneumoperitoneum creation, the IAP was sequentially raised to three predefined IAP levels (8, 11 and 14 mmHg), keeping identical ventilatory settings (timepoints T1, T2, and T3). After that, positive end-expiratory pressure (PEEP) was sequentially raised from 5 to 8 to 11 cmHO (timepoint T4 and T5). The primary outcome included ventilatory MP delivery at each timepoint. Other variables included respiratory driving pressure (DP), airway resistance (AR), and respiratory compliance (RC).
The MP increased linearly with a rise in IAP from T1 to T3 ( = 0.71, < 0.001); the MP increased by 0.19 per unit rise in IAP (effect size 0.90, < 0.001). A similar positive correlation was also observed between DP and IAP from T1 to T3 ( = 0.73, < 0.001); the DP increased by 0.72 per unit rise in IAP (effect size 0.89, < 0.001). The MP increased significantly on increasing PEEP from T3 to T5, while the DP decreased concomitantly ( < 0.001). The AR increased significantly from T1 to T3, while RC decreased concomitantly; vice-versa was observed at T4 and T5 ( < 0.001).
The ventilatory MP delivery rises linearly with an increase in IAP. Targeting an IAP-guided MP level could be an attractive approach to minimize lung injury.
腹腔镜手术建立气腹会增加腹内压并导致肺泡萎陷。我们研究了在腹腔镜胆囊切除术建立气腹过程中腹内压（IAP）升高对通气机械功率（MP）输送的影响。
采用前瞻性队列设计，我们纳入了42例行腹腔镜胆囊切除术的患者。在建立气腹过程中，将IAP依次升高至三个预定义的IAP水平（8、11和14 mmHg），保持相同的通气设置（时间点T1、T2和T3）。之后，呼气末正压（PEEP）依次从5 cmH₂O升高至8 cmH₂O再到11 cmH₂O（时间点T4和T5）。主要结局包括每个时间点的通气MP输送。其他变量包括呼吸驱动压（DP）、气道阻力（AR）和呼吸顺应性（RC）。
从T1到T3，MP随IAP升高呈线性增加（r = 0.71，P < 0.001）；IAP每升高一个单位，MP增加0.19（效应量0.90，P < 0.001）。从T1到T3，DP与IAP之间也观察到类似的正相关（r = 0.73，P < 0.001）；IAP每升高一个单位，DP增加0.72（效应量0.89，P < 0.001）。从T3到T5增加PEEP时，MP显著增加，而DP随之降低（P < 0.001）。从T1到T3，AR显著增加，而RC随之降低；在T4和T5观察到相反情况（P < 0.001）。
通气MP输送随IAP升高呈线性增加。以IAP指导的MP水平为目标可能是一种减少肺损伤的有吸引力的方法。
