Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study

Background: Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10-cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. Method: After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2-10 years, undergoing LAP were randomized to receive PEEP of 5- or 10-cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. Results: The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Conclusion: Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.