• Yun Wang, Hong Wang, Huijuan Wang, Xiao Zhao, Shitong Li, and Lianhua Chen.
• Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China.
• Ann Transl Med. 2019 Apr 1; 7 (8): 171.

BackgroundThe intraoperative lung protective effect of mechanical ventilation of different positive end-expiratory pressure (PEEP) levels on patients undergoing abdominal laparoscopic surgery with the steep Trendelenburg position remains undefined. The purpose of the study was to explore the optimal PEEP.MethodsSixty patients scheduled for abdominal laparoscopic surgery were randomized to four groups including: PEEP 0, 4, 8 and 12 cmH2O. The pulmonary dynamic compliance (Cdyn), dead space to tidal volume ratio (VD/VT), and intrapulmonary shunt ratio (QS/QT) were measured after anesthesia induction (T0), 5 min after pneumoperitoneum (PNP) with position change (T1), 30 (T2) and 60 min (T3) after PEEP, and end of surgery (T4).ResultsCdyn increased when different levels of PEEP (including the 4, 8, and 12 cmH2O) were used vs. no PEEP (P<0.05). The VD/VT in PEEP 8 and 12 cmH2O were significantly improved than no PEEP (P<0.05). Meanwhile, the QS/QT in PEEP 12 cmH2O was higher than others during the procedures.ConclusionsA moderate PEEP level (8 cmH2O) with low tidal volume was sufficient to improve Cdyn and to decrease VD/VT without increasing QS/QT, which was suggested to be a good choice of intraoperative lung protective ventilation during abdominal laparoscopic surgery with Trendelenburg position.

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