• Mohamed Elshazly, Tamer Khair, Marina Bassem, and Mohamed Mansour.
• Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Cairo, Egypt. Electronic address: dr.mohamed.elshazly8686@gmail.com.
• Surg Obes Relat Dis. 2021 Feb 1; 17 (2): 372-378.

BackgroundAnesthetic management of patients with obesity undergoing laparoscopic abdominal surgeries requires careful plan for intraoperative mechanical ventilation aiming to avoid lung atelectasis and/or overdistention. There are conflicting data on the optimum positive end expiratory pressure (PEEP) during these surgeries. We hypothesized that lung ultrasound could be used for PEEP titration during laparoscopic surgery.ObjectiveThe purpose of this study is to evaluate the effectiveness of intraoperative individualized lung ultrasound-guided PEEP in obese patients undergoing laparoscopic bariatric surgery on intraoperative partial arterial oxygen tension (PaO2) and early postoperative pulmonary complications.MethodsA randomized controlled trial included 40 adult patients with body mass index (BMI) > 35 kg/m2 undergoing laparoscopic bariatric surgery. Patients were randomized into: control group (n = 20) who received PEEP 4 cm.H2 O and ultrasound-guided group (n = 20) who received individualized lung ultrasound stepwise PEEP. All patients received volume-controlled ventilation with a tidal volume of 6 mL/kg of ideal weight and a fraction of inspired oxygen of .5. The primary outcome was the difference in partial arterial oxygen tension (PaO2) between the control group and the ultrasound-guided group. The secondary outcomes included the incidence of early postoperative pulmonary atelectasis, respiratory failure, bronchospasm, hypoxia or pneumothorax.SettingsGeneral surgery operating theatre at Cairo University hospitals.ResultsUltrasound-guided group showed higher PO2 after PEEP optimization and postoperatively compared with control group (P = .005, and P = .01 respectively). Also, ultrasound-guided group showed no postoperative complications compared with control group that had 5 cases who developed postoperative pulmonary complications in the form of hypoxia and basal collapse in the first 24 hour postoperatively chest x ray (0% versus 25%, P = .047).ConclusionIn patients with obesity undergoing laparoscopic bariatric surgery, the use of lung ultrasound individualized stepwise PEEP approach improved oxygenation, compliance and reduced the incidence of postoperative pulmonary atelectasis and hypoxia without causing hemodynamic instability.Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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