Intraoperative PEEP Setting During Laparoscopic Gynecologic Surgery

As minimally invasive procedure with numerous advantages compared with open surgery, laparoscopic surgery has been substantially performed worldwide. The creation of pneumoperitoneum during laparoscopic surgery, however, can have significant effects on the respiratory system including decreased respiratory system compliance, decreased vital capacity and functional residual capacity and atelectasis formation. These pathophysiologic changes may put patients at risk of postoperative pulmonary complications. Therefore, intraoperative mechanical ventilation, especially setting of positive end-expiratory pressure (PEEP) has an important role in respiratory management during laparoscopic surgery. Nevertheless, there is no consensus on the optimal PEEP level and the best method to set PEEP during laparoscopic surgery. In patients with acute respiratory distress syndrome, PEEP set according to pleural pressure measured by using esophageal balloon catheter significantly has beneficial effects in terms of oxygenation, compliance and possible mortality. The aim of this study is to determine whether setting of PEEP guided by measurement of pleural pressure would improve oxygenation and respiratory system compliance during laparoscopic surgery.

Inclusion criteria

• Patients with age of equal or more than 18 years old undergoing laparoscopic gynecologic surgery with anticipated surgical duration of more than 2 hours

Exclusion criteria

• Patients with ASA physical status of equal or more than 3
• Patients with significant cardiovascular or respiratory diseases
• Patients with significant pathological lesion in pharynx and esophagus that preclude placement of esophageal balloon catheter
• Patients with contraindications for PEEP titration such as increased intracranial pressure or unstable hemodynamic
• Patients with arrhythmias
• Patients who refuse to provide written informed consent
• Patients undergoing surgery with duration of less than 2 hours