Peddyandhari Fildza Sasri, Ramlan Andi Ade Wijaya, Manggala Sidharta Kusuma, Harzif Achmad Kemal, Nada Amina, Rahardja Theodorus Samuel
Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Biomed Phys Eng Express. 2025 Jun 20;11(4). doi: 10.1088/2057-1976/ade159.
Increased intra-abdominal pressure (IAP) that is frequently found on patients requiring mechanical ventilation in the intensive care unit (ICU) can disrupt splanchnic perfusion and ventilation management. Elevated IAP, resulting from various factors including hemorrhage or abdominal masses, can lead to multi-organ dysfunction if not managed effectively. Interestingly, IAP is also prevalent in healthy individuals undergoing laparoscopic surgery, making it a valuable model for studying ventilation strategies applicable to critically ill patients. This study investigates the effects of varying positive end-expiratory pressure (PEEP) levels on end-expiratory lung impedance (EELI) during laparoscopic procedures, hypothesizing that alterations in PEEP can significantly influence EELI, particularly in dependent lung regions. Conducted at Cipto Mangunkusumo Hospital, this prospective cohort study included adult patients without severe pulmonary or cardiovascular conditions, assessing EELI through electrical impedance tomography (EIT). EIT was used to assess global and regional EELI changes at PEEP levels of 5, 8 11 and 14 cmHO following COinsufflation. The findings indicated that insufflation raised global EELI (ΔEELI-G) following PEEP adjustments, which contradicts expectations from increased IAP. Regional analysis highlighted that dependent lung areas exhibited more significant changes, suggesting a complex relationship between PEEP and lung mechanics during elevated IAP. Despite no adverse respiratory complications observed, obesity notably influenced EELI post-anesthesia, underscoring the necessity for tailored PEEP strategies to enhance pulmonary function in at-risk populations. This study advances understanding of optimal ventilatory management in patients with altered IAP and calls for further investigation into individualized PEEP applications and the exploration of advanced imaging modalities for lung assessment.
在重症监护病房（ICU）中，需要机械通气的患者经常出现腹腔内压力（IAP）升高的情况，这可能会扰乱内脏灌注和通气管理。由包括出血或腹部肿块在内的各种因素导致的IAP升高，如果得不到有效管理，可能会导致多器官功能障碍。有趣的是，IAP在接受腹腔镜手术的健康个体中也很普遍，这使其成为研究适用于危重病患者通气策略的有价值模型。本研究调查了腹腔镜手术过程中不同呼气末正压（PEEP）水平对呼气末肺阻抗（EELI）的影响，假设PEEP的改变会显著影响EELI，特别是在肺下垂部位。这项前瞻性队列研究在西托·曼古库苏莫医院进行，纳入了没有严重肺部或心血管疾病的成年患者，通过电阻抗断层扫描（EIT）评估EELI。EIT用于评估气腹后PEEP水平为5、8、11和14 cmH₂O时全球和区域EELI的变化。研究结果表明，气腹后调整PEEP会使全球EELI（ΔEELI-G）升高，这与IAP升高的预期结果相矛盾。区域分析突出显示，肺下垂部位的变化更为显著，这表明IAP升高期间PEEP与肺力学之间存在复杂关系。尽管未观察到不良呼吸并发症，但肥胖显著影响麻醉后的EELI，这强调了制定个性化PEEP策略以改善高危人群肺功能的必要性。本研究增进了对IAP改变患者最佳通气管理的理解，并呼吁进一步研究个性化PEEP的应用以及探索用于肺部评估的先进成像模式。
