Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial
Robot-assisted laparoscopic radical prostatectomy requires general anaesthesia, extreme Trendelenburg positioning and capnoperitoneum. Together these promote impaired pulmonary gas exchange caused by atelectasis and may contribute to postoperative pulmonary complications. In morbidly obese patients,...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2020-09, Vol.125 (3), p.373-382 |
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| creator | Girrbach, Felix Petroff, David Schulz, Susann Hempel, Gunther Lange, Mirko Klotz, Carolin Scherz, Stephanie Giannella-Neto, Antonio Beda, Alessandro Jardim-Neto, Alcendino Stolzenburg, Jens-Uwe Reske, Andreas W. Wrigge, Hermann Simon, Philipp |
| description | Robot-assisted laparoscopic radical prostatectomy requires general anaesthesia, extreme Trendelenburg positioning and capnoperitoneum. Together these promote impaired pulmonary gas exchange caused by atelectasis and may contribute to postoperative pulmonary complications. In morbidly obese patients, a recruitment manoeuvre (RM) followed by individualised PEEP improves intraoperative oxygenation and end-expiratory lung volume (EELV). We hypothesised that individualised PEEP with initial RM similarly improves intraoperative oxygenation and EELV in non-obese individuals undergoing robot-assisted prostatectomy.
Forty males (age, 49–76 yr; BMI |
| doi_str_mv | 10.1016/j.bja.2020.05.041 |
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Forty males (age, 49–76 yr; BMI <30 kg m−2) undergoing prostatectomy received volume-controlled ventilation (tidal volume 8 ml kg−1 predicted body weight). Participants were randomised to either (1) RM followed by individualised PEEP (RM/PEEPIND) optimised using electrical impedance tomography or (2) no RM with 5 cm H2O PEEP. The primary outcome was the ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2/Fio2) before the last RM before extubation. Secondary outcomes included regional ventilation distribution and EELV which were measured before, during, and after anaesthesia. The cardiovascular effects of RM/PEEPIND were also assessed.
In 20 males randomised to RM/PEEPIND, the median PEEPIND was 14 cm H2O [inter-quartile range, 8–20]. The Pao2/Fio2 was 10.0 kPa higher with RM/PEEPIND before extubation (95% confidence interval [CI], 2.6–17.3 kPa; P=0.001). RM/PEEPIND increased end-expiratory lung volume by 1.49 L (95% CI, 1.09–1.89 L; P<0.001). RM/PEEPIND also improved the regional ventilation of dependent lung regions. Vasopressor and fluid therapy was similar between groups, although 13 patients randomised to RM/PEEPIND required pharmacological therapy for bradycardia.
In non-obese males, an individualised ventilation strategy improved intraoperative oxygenation, which was associated with higher end-expiratory lung volumes during robot-assisted laparoscopic prostatectomy.
DRKS00004199 (German clinical trials registry)</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2020.05.041</identifier><language>eng</language><publisher>Elsevier Ltd</publisher><subject>electrical impedance tomography ; minimally invasive surgery ; positive pressure ventilation ; pulmonary gas exchange ; radical prostatectomy</subject><ispartof>British journal of anaesthesia : BJA, 2020-09, Vol.125 (3), p.373-382</ispartof><rights>2020 British Journal of Anaesthesia</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-842d4d5e9c1418069f9cf927cae7402bfd6365f6604d1060744d8f79a41bcbde3</citedby><cites>FETCH-LOGICAL-c373t-842d4d5e9c1418069f9cf927cae7402bfd6365f6604d1060744d8f79a41bcbde3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Girrbach, Felix</creatorcontrib><creatorcontrib>Petroff, David</creatorcontrib><creatorcontrib>Schulz, Susann</creatorcontrib><creatorcontrib>Hempel, Gunther</creatorcontrib><creatorcontrib>Lange, Mirko</creatorcontrib><creatorcontrib>Klotz, Carolin</creatorcontrib><creatorcontrib>Scherz, Stephanie</creatorcontrib><creatorcontrib>Giannella-Neto, Antonio</creatorcontrib><creatorcontrib>Beda, Alessandro</creatorcontrib><creatorcontrib>Jardim-Neto, Alcendino</creatorcontrib><creatorcontrib>Stolzenburg, Jens-Uwe</creatorcontrib><creatorcontrib>Reske, Andreas W.</creatorcontrib><creatorcontrib>Wrigge, Hermann</creatorcontrib><creatorcontrib>Simon, Philipp</creatorcontrib><title>Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial</title><title>British journal of anaesthesia : BJA</title><description>Robot-assisted laparoscopic radical prostatectomy requires general anaesthesia, extreme Trendelenburg positioning and capnoperitoneum. Together these promote impaired pulmonary gas exchange caused by atelectasis and may contribute to postoperative pulmonary complications. In morbidly obese patients, a recruitment manoeuvre (RM) followed by individualised PEEP improves intraoperative oxygenation and end-expiratory lung volume (EELV). We hypothesised that individualised PEEP with initial RM similarly improves intraoperative oxygenation and EELV in non-obese individuals undergoing robot-assisted prostatectomy.
Forty males (age, 49–76 yr; BMI <30 kg m−2) undergoing prostatectomy received volume-controlled ventilation (tidal volume 8 ml kg−1 predicted body weight). Participants were randomised to either (1) RM followed by individualised PEEP (RM/PEEPIND) optimised using electrical impedance tomography or (2) no RM with 5 cm H2O PEEP. The primary outcome was the ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2/Fio2) before the last RM before extubation. Secondary outcomes included regional ventilation distribution and EELV which were measured before, during, and after anaesthesia. The cardiovascular effects of RM/PEEPIND were also assessed.
In 20 males randomised to RM/PEEPIND, the median PEEPIND was 14 cm H2O [inter-quartile range, 8–20]. The Pao2/Fio2 was 10.0 kPa higher with RM/PEEPIND before extubation (95% confidence interval [CI], 2.6–17.3 kPa; P=0.001). RM/PEEPIND increased end-expiratory lung volume by 1.49 L (95% CI, 1.09–1.89 L; P<0.001). RM/PEEPIND also improved the regional ventilation of dependent lung regions. Vasopressor and fluid therapy was similar between groups, although 13 patients randomised to RM/PEEPIND required pharmacological therapy for bradycardia.
In non-obese males, an individualised ventilation strategy improved intraoperative oxygenation, which was associated with higher end-expiratory lung volumes during robot-assisted laparoscopic prostatectomy.
DRKS00004199 (German clinical trials registry)</description><subject>electrical impedance tomography</subject><subject>minimally invasive surgery</subject><subject>positive pressure ventilation</subject><subject>pulmonary gas exchange</subject><subject>radical prostatectomy</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc-OFCEQxonRxHH1Abxx9GD3FgzdTOvJbPyzySZe9ExoqF6Z0A0CPbHfzweTmfG8J4rK96t8VR8hbxm0DFh_e2zHo245cGiha0GwZ2THhGRNLyV7TnYAIBsYGH9JXuV8BGCSD92O_L1frDs5u2rvMloaQ3bFnZDiYhv8E13SJaSNxoQ5rwnp4-ps1Y0bRY-mJGe0p26OaPVikJYwh8ek46-NTiHRFMZQGp2zy6VSXkedQjYhOkOTthc41k7RpQ4L8_aB6ksj1m-18b6qFhvmizcTlpKC9-fSu-UCVwPavyYvJu0zvvn_3pCfXz7_uPvWPHz_en_36aExe7kvzUFwK2yHg2GCHaAfpsFMA5dGoxTAx8n2-76b-h6EZdCDFMIeJjlowUYzWtzfkHfXudXh7xVzUdWYQe_1gmHNigsuGHA-iCplV6mpy-SEk4rJzTptioE6J6aOqiamzokp6FRNrDIfrwzWHU4Ok8rGYb2qdameQ9ngnqD_Ad3GpYw</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Girrbach, Felix</creator><creator>Petroff, David</creator><creator>Schulz, Susann</creator><creator>Hempel, Gunther</creator><creator>Lange, Mirko</creator><creator>Klotz, Carolin</creator><creator>Scherz, Stephanie</creator><creator>Giannella-Neto, Antonio</creator><creator>Beda, Alessandro</creator><creator>Jardim-Neto, Alcendino</creator><creator>Stolzenburg, Jens-Uwe</creator><creator>Reske, Andreas W.</creator><creator>Wrigge, Hermann</creator><creator>Simon, Philipp</creator><general>Elsevier Ltd</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202009</creationdate><title>Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial</title><author>Girrbach, Felix ; Petroff, David ; Schulz, Susann ; Hempel, Gunther ; Lange, Mirko ; Klotz, Carolin ; Scherz, Stephanie ; Giannella-Neto, Antonio ; Beda, Alessandro ; Jardim-Neto, Alcendino ; Stolzenburg, Jens-Uwe ; Reske, Andreas W. ; Wrigge, Hermann ; Simon, Philipp</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-842d4d5e9c1418069f9cf927cae7402bfd6365f6604d1060744d8f79a41bcbde3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>electrical impedance tomography</topic><topic>minimally invasive surgery</topic><topic>positive pressure ventilation</topic><topic>pulmonary gas exchange</topic><topic>radical prostatectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Girrbach, Felix</creatorcontrib><creatorcontrib>Petroff, David</creatorcontrib><creatorcontrib>Schulz, Susann</creatorcontrib><creatorcontrib>Hempel, Gunther</creatorcontrib><creatorcontrib>Lange, Mirko</creatorcontrib><creatorcontrib>Klotz, Carolin</creatorcontrib><creatorcontrib>Scherz, Stephanie</creatorcontrib><creatorcontrib>Giannella-Neto, Antonio</creatorcontrib><creatorcontrib>Beda, Alessandro</creatorcontrib><creatorcontrib>Jardim-Neto, Alcendino</creatorcontrib><creatorcontrib>Stolzenburg, Jens-Uwe</creatorcontrib><creatorcontrib>Reske, Andreas W.</creatorcontrib><creatorcontrib>Wrigge, Hermann</creatorcontrib><creatorcontrib>Simon, Philipp</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Girrbach, Felix</au><au>Petroff, David</au><au>Schulz, Susann</au><au>Hempel, Gunther</au><au>Lange, Mirko</au><au>Klotz, Carolin</au><au>Scherz, Stephanie</au><au>Giannella-Neto, Antonio</au><au>Beda, Alessandro</au><au>Jardim-Neto, Alcendino</au><au>Stolzenburg, Jens-Uwe</au><au>Reske, Andreas W.</au><au>Wrigge, Hermann</au><au>Simon, Philipp</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><date>2020-09</date><risdate>2020</risdate><volume>125</volume><issue>3</issue><spage>373</spage><epage>382</epage><pages>373-382</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Robot-assisted laparoscopic radical prostatectomy requires general anaesthesia, extreme Trendelenburg positioning and capnoperitoneum. Together these promote impaired pulmonary gas exchange caused by atelectasis and may contribute to postoperative pulmonary complications. In morbidly obese patients, a recruitment manoeuvre (RM) followed by individualised PEEP improves intraoperative oxygenation and end-expiratory lung volume (EELV). We hypothesised that individualised PEEP with initial RM similarly improves intraoperative oxygenation and EELV in non-obese individuals undergoing robot-assisted prostatectomy.
Forty males (age, 49–76 yr; BMI <30 kg m−2) undergoing prostatectomy received volume-controlled ventilation (tidal volume 8 ml kg−1 predicted body weight). Participants were randomised to either (1) RM followed by individualised PEEP (RM/PEEPIND) optimised using electrical impedance tomography or (2) no RM with 5 cm H2O PEEP. The primary outcome was the ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2/Fio2) before the last RM before extubation. Secondary outcomes included regional ventilation distribution and EELV which were measured before, during, and after anaesthesia. The cardiovascular effects of RM/PEEPIND were also assessed.
In 20 males randomised to RM/PEEPIND, the median PEEPIND was 14 cm H2O [inter-quartile range, 8–20]. The Pao2/Fio2 was 10.0 kPa higher with RM/PEEPIND before extubation (95% confidence interval [CI], 2.6–17.3 kPa; P=0.001). RM/PEEPIND increased end-expiratory lung volume by 1.49 L (95% CI, 1.09–1.89 L; P<0.001). RM/PEEPIND also improved the regional ventilation of dependent lung regions. Vasopressor and fluid therapy was similar between groups, although 13 patients randomised to RM/PEEPIND required pharmacological therapy for bradycardia.
In non-obese males, an individualised ventilation strategy improved intraoperative oxygenation, which was associated with higher end-expiratory lung volumes during robot-assisted laparoscopic prostatectomy.
DRKS00004199 (German clinical trials registry)</abstract><pub>Elsevier Ltd</pub><doi>10.1016/j.bja.2020.05.041</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | electrical impedance tomography minimally invasive surgery positive pressure ventilation pulmonary gas exchange radical prostatectomy |
| title | Individualised positive end-expiratory pressure guided by electrical impedance tomography for robot-assisted laparoscopic radical prostatectomy: a prospective, randomised controlled clinical trial |
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