Effects of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of driving pressure-guided individualized PEEP ventilation on intraoperative cardiac function in elderly patients undergoing laparoscopic surgery.Methods:Seventy American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 60-75 yr, with body mass index of 18-25 kg/m 2, with left ventricular ejection fraction (LVEF)>50%, undergoing elective laparoscopic radical gastrectomy under general anesthesia, were divided into 2 groups ( n=35 each) by the random number table method: conventional PEEP ventilation group (group P) and driving pressure-guided individualized PEEP ventilation group (group D). The patients were mechanically ventilated in the volume-controlled ventilation mode, with a V T of 7 ml/kg, an inspired oxygen concentration of 60%, an inspiratory/expiratory ratio of 1∶2, and an end-inspiratory pause time of 10%.In group P, 5 cmH 2O PEEP was given for ventilation from 5 min after the establishment of pneumoperitoneum until the end of operation.In group D, driving pressure-guided individualized PEEP titration was performed at 5 min after the establishment of pneumoperitoneum, and ventilation was maintained with the titrated individualized PEEP until the pneumoperitoneum was closed.After the pneumoperitoneum was closed, group D underwent driving pressure-directed individualized PEEP again, and ventilation was maintained with re-titrated PEEP until the end of surgery.Before pneumoperitoneum (T 0), at 5 min after establishment of pneumoperitoneum (T 1), 5 min of PEEP ventilation (T 2), 30 min of PEEP ventilation (T 3) and 5 min after the end of pneumoperitoneum (T 4), MAP was recorded, LVEF, global longitudinal strain of left ventricle, tricuspid annular systolic displacement, early diastolic peak velocity (E peak) of mitral valve and tricuspid valve orifice, early diastolic peak velocity (e′) and systole peak velocity (S′) of mitral valve and tricuspid valve annulus were measured using transesophageal ultrasonography, and myocardial performance index (MPI) and E/e′ were calculated. Results:Compared with group P, MAP, LVEF, mitral valve annulus S′, global longitudinal strain of left ventricle, tricuspid valve annulus S′, and tricuspid annular systolic displacement were significantly decreased at T 2 and T 3, and left ventricular MPI, mitral valve E/e′, right ventricular MPI and tricuspid E/e′ were increased in group D ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the cardiac function during pneumoperitoneum in elderly patients undergoing laparoscopic surgery.