Effects of individualized high positive end-expiratory pressure and crystalloid administration on postoperative pulmonary function in patients undergoing robotic-assisted radical prostatectomy: a prospective randomized single-blinded pilot study
Abstract Background Robotic-assisted laparoscopic prostatectomy (RALP) using a combination of capnoperitoneum and steep Trendelenburg positioning (STP) results in important pathophysiological pulmonary changes. The aim of the study was to evaluate if restrictive crystalloid administration and individual management of positive end-expiratory pressure (PEEP) improve peri- and postoperative pulmonary function in patients undergoing RALP in permanent 45 degree STP.Methods 98 patients undergoing RALP under standardized anesthesia were either allocated to a standard PEEP (5 mmHg) group or an individualized high PEEP group. Furthermore, each group was divided into a liberal vs restrictive crystalloid group (30 ml vs 15 ml per kg predicted body weight). Individualized PEEP levels were determined by means of preoperative PEEP titration in STP. In each of the four study groups following intraoperative parameters were analyzed: ventilation setting (PIP, driving pressure [Pdriv], lung compliance [LC], mechanical power [MP]), and postoperative pulmonary function (bed-side spirometry). The following spirometric parameters were measured pre- and postoperatively: the Tiffeneau index (FEV1/FVC ratio) and mean forced expiratory flow (FEF25 − 75). Data are shown as mean ± standard deviation (SD), and groups were compared with ANOVA. A P-value of < 0.05 was considered significant.Results The two individualized high PEEP groups (mean PEEP 15.5 [± 1.71 cmH2O]) showed significantly higher PIP and MP levels but significantly decreased Pdriv and increased LC. On the first and second postoperative day, patients with individualized higher PEEP levels had a significantly higher mean Tiffeneau index (day 1: 77.6% (± 6.6) vs 73.6% (± 8.8), P = 0.014; day 2: 76.5% (± 6.1) vs 72.7% (± 9.3), P = 0.021) and FEF25 − 75 (day 1: 2.41 liter/sec (± 0.9) vs 1.95 liter/sec (± 0.8), P = 0.009; day 2: 2.45 liter/sec (± 0.9) vs 2.07 liter/sec (± 0.8), P = 0.033). Perioperative oxygenation and postoperative spirometric parameters were not influenced by restrictive or liberal crystalloid infusion in either of the two PEEP groups.Conclusions Higher individualized PEEP levels during RALP improved blood oxygenation, lung-protective ventilation, and postoperative pulmonary function up to 48 hours after surgery. Restrictive crystalloid infusion during RALP seemed to have no effect on peri- and postoperative oxygenation and pulmonary function..
| Medienart: |
|
|---|
Preprint| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 28. Feb. Zur Gesamtaufnahme - year:2022 |
|---|
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Blecha, Sebastian [VerfasserIn] |
|---|
| Links: |
Volltext [kostenfrei] |
|---|
| doi: |
10.21203/rs.3.rs-625423/v1 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
XRA033736375 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | XRA033736375 | ||
| 003 | DE-627 | ||
| 005 | 20230429174303.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 220113s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.21203/rs.3.rs-625423/v1 |2 doi | |
| 035 | |a (DE-627)XRA033736375 | ||
| 035 | |a (ResearchSquare)10.21203/rs.3.rs-625423/v1 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 082 | 0 | |a 570 |q DE-84 | |
| 100 | 1 | |a Blecha, Sebastian |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effects of individualized high positive end-expiratory pressure and crystalloid administration on postoperative pulmonary function in patients undergoing robotic-assisted radical prostatectomy: a prospective randomized single-blinded pilot study |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Abstract Background Robotic-assisted laparoscopic prostatectomy (RALP) using a combination of capnoperitoneum and steep Trendelenburg positioning (STP) results in important pathophysiological pulmonary changes. The aim of the study was to evaluate if restrictive crystalloid administration and individual management of positive end-expiratory pressure (PEEP) improve peri- and postoperative pulmonary function in patients undergoing RALP in permanent 45 degree STP.Methods 98 patients undergoing RALP under standardized anesthesia were either allocated to a standard PEEP (5 mmHg) group or an individualized high PEEP group. Furthermore, each group was divided into a liberal vs restrictive crystalloid group (30 ml vs 15 ml per kg predicted body weight). Individualized PEEP levels were determined by means of preoperative PEEP titration in STP. In each of the four study groups following intraoperative parameters were analyzed: ventilation setting (PIP, driving pressure [Pdriv], lung compliance [LC], mechanical power [MP]), and postoperative pulmonary function (bed-side spirometry). The following spirometric parameters were measured pre- and postoperatively: the Tiffeneau index (FEV1/FVC ratio) and mean forced expiratory flow (FEF25 − 75). Data are shown as mean ± standard deviation (SD), and groups were compared with ANOVA. A P-value of < 0.05 was considered significant.Results The two individualized high PEEP groups (mean PEEP 15.5 [± 1.71 cmH2O]) showed significantly higher PIP and MP levels but significantly decreased Pdriv and increased LC. On the first and second postoperative day, patients with individualized higher PEEP levels had a significantly higher mean Tiffeneau index (day 1: 77.6% (± 6.6) vs 73.6% (± 8.8), P = 0.014; day 2: 76.5% (± 6.1) vs 72.7% (± 9.3), P = 0.021) and FEF25 − 75 (day 1: 2.41 liter/sec (± 0.9) vs 1.95 liter/sec (± 0.8), P = 0.009; day 2: 2.45 liter/sec (± 0.9) vs 2.07 liter/sec (± 0.8), P = 0.033). Perioperative oxygenation and postoperative spirometric parameters were not influenced by restrictive or liberal crystalloid infusion in either of the two PEEP groups.Conclusions Higher individualized PEEP levels during RALP improved blood oxygenation, lung-protective ventilation, and postoperative pulmonary function up to 48 hours after surgery. Restrictive crystalloid infusion during RALP seemed to have no effect on peri- and postoperative oxygenation and pulmonary function. | ||
| 700 | 1 | |a Hager, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Gross, Verena |e verfasserin |4 aut | |
| 700 | 1 | |a Seyfried, Timo |e verfasserin |4 aut | |
| 700 | 1 | |a Zeman, Florian |e verfasserin |4 aut | |
| 700 | 1 | |a Lubnow, Matthias |e verfasserin |4 aut | |
| 700 | 1 | |a Burger, Maximilian |e verfasserin |4 aut | |
| 700 | 1 | |a Pawlik, Michael |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t ResearchSquare.com |g (2022) vom: 28. Feb. |
| 773 | 1 | 8 | |g year:2022 |g day:28 |g month:02 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.21203/rs.3.rs-625423/v1 |z kostenfrei |3 Volltext |
| 912 | |a GBV_XRA | ||
| 912 | |a SSG-OLC-PHA | ||
| 951 | |a AR | ||
| 952 | |j 2022 |b 28 |c 02 | ||
| 953 | |2 045F |a 570 | ||