Does Lung Compliance Optimization Through PEEP Manipulations Reduce the Incidence of Postoperative Hypoxemia in Laparoscopic Bariatric Surgery? A Randomized Trial

Background In obese patients (OP), the best intraoperative ventilation strategy remains to be defined. Dynamic lung compliance ( C dyn ) and dead space fraction are indicators of efficient ventilation at an optimal positive end-expiratory pressure (PEEP). Herein, we investigated whether intraoperati...

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Published in:	Obesity surgery Vol. 29; no. 4; pp. 1268 - 1275
Main Authors:	Van Hecke, Delphine, Bidgoli, Javad S., Van der Linden, Philippe
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-04-2019 Springer Nature B.V
Subjects:	Adult Bariatric Surgery - adverse effects Bariatric Surgery - methods Female Gastrointestinal surgery Humans Hypoxia - epidemiology Hypoxia - etiology Hypoxia - prevention & control Incidence Laparoscopy Laparoscopy - adverse effects Lung - physiology Lung Compliance - physiology Male Medicine Medicine & Public Health Middle Aged Obesity, Morbid - epidemiology Obesity, Morbid - physiopathology Obesity, Morbid - surgery Original Contributions Positive-Pressure Respiration - methods Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Postoperative Period Prospective Studies Respiration Surgery Tidal Volume Ventilation Anesthetic management Lung compliance Positive end-expiratory pressure Mechanical ventilation Laparoscopic bariatric surgery Postoperative hypoxemia
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Summary:	Background In obese patients (OP), the best intraoperative ventilation strategy remains to be defined. Dynamic lung compliance ( C dyn ) and dead space fraction are indicators of efficient ventilation at an optimal positive end-expiratory pressure (PEEP). Herein, we investigated whether intraoperative dynamic lung compliance optimization through PEEP manipulations affects the incidence of postoperative hypoxemia (SpO 2 < 90%) in OP undergoing laparoscopic bariatric surgery (LBS). Methods This was a single-center, prospective, randomized controlled study conducted from July 2013 to December 2015. After obtaining institutional review board approval and informed consent, 100 OP undergoing LBS under volume-controlled ventilation (tidal volume 8 mL/kg of ideal body weight) were randomized according to the PEEP level maintained during the surgery. In the control group, a PEEP of 10 cm H 2 O was maintained, while in the intervention group, the PEEP was adapted to achieve the best dynamic lung compliance. Anesthesia and analgesia were standardized. The patients received supplemental nasal oxygen on the first postoperative day and were monitored up to the second postoperative day with a portable pulse oximeter. Results Demographics were similar between groups. There was no difference in the incidence of hypoxemia during the first 2 postoperative days (control: 1.3%; intervention: 2.1%; p = 0.264). Conclusions The incidence of postoperative hypoxemia was not reduced by an open-lung approach with protective ventilation strategy in obese patients undergoing LBS. A pragmatic application of a PEEP level of 10 cm H 2 O was comparable to individual PEEP titration in these patients. Trial Registration Clinicaltrials.gov identifier, NCT02579798; https://clinicaltrials.gov/ct2/show/NCT02579798
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ISSN:	0960-8923 1708-0428
DOI:	10.1007/s11695-018-03662-x