Intraoperative right heart function with individualized mechanical ventilation in laparoscopic surgery with...

Area of Science:

• Anesthesiology
• Cardiology
• Critical Care Medicine

Background:

• The impact of individualized positive end-expiratory pressure (PEEP) during mechanical ventilation on right heart function in surgical settings is not well understood.
• Laparoscopic surgery in the Trendelenburg position presents unique physiological challenges.

Purpose of the Study:

• To compare the effects of individualized PEEP (titrimetric) versus standard PEEP on right heart function during laparoscopic abdominal surgery.
• To determine if individualized ventilation offers superior right heart protection compared to standard ventilation.

Main Methods:

• Forty patients undergoing abdominal laparoscopic surgery were randomized into two groups: titrimetric PEEP (Group T) and standard PEEP (Group I, 5 cmH2O).
• Right ventricular function was assessed using transesophageal echocardiography, measuring tricuspid annular plane systolic excursion, RV E/A ratio, and RV/LV end-diastolic area ratio.
• Measurements were taken during mechanical ventilation in the Trendelenburg position.

Main Results:

• No significant differences in tricuspid annular plane systolic excursion or right ventricle early-to-late filling (E/A) ratio were observed between the groups.
• Both groups showed a significant increase in the right ventricular end-diastolic area/left ventricular end-diastolic area ratio from baseline to the end of the procedure.
• This indicates a potential increase in RV preload or volume in both ventilation strategies.

Conclusions:

• Lung-protective mechanical ventilation using dynamic compliance-guided PEEP does not appear to negatively impact right heart function.
• Individualized PEEP ventilation is comparable to standard protective ventilation regarding right heart function during laparoscopic surgery in the Trendelenburg position.
• The findings support the safety of dynamic compliance-guided PEEP in maintaining right ventricular function during this surgical procedure.