• Annop Piriyapatsom and Sanchai Phetkampang.
• From the Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (AP, SP).
• Eur J Anaesthesiol. 2020 Nov 1; 37 (11): 1032-1039.

BackgroundThe creation of pneumoperitoneum during laparoscopic surgery can lead to adverse effects on the respiratory system. Positive end-expiratory pressure (PEEP) plays an important role in mechanical ventilation during laparoscopic surgery.ObjectiveTo evaluate whether PEEP setting guided by oesophageal pressure (Poeso) measurement would affect oxygenation and respiratory mechanics during laparoscopic gynaecological surgery.DesignA randomised controlled study.SettingA single-centre trial from March 2018 to June 2018.PatientsForty-four adult patients undergoing laparoscopic gynaecological surgery with anticipated duration of surgery more than 2 h.InterventionPEEP set according to Poeso measurement (intervention group) versus PEEP constantly set at 5 cmH2O (control group).Main Outcome MeasuresGas exchange and respiratory mechanics after induction and intubation (T0) and at 15 and 60 min after initiation of pneumoperitoneum (T1 and T2, respectively).ResultsPEEP during pneumoperitoneum was significantly higher in the intervention group than in the control group (T1, 12.5 ± 1.9 vs. 5.0 ± 0.0 cmH2O and T2, 12.4 ± 1.9 vs. 5.0 ± 0.0 cmH2O, both P < 0.001). Partial pressures of oxygen decreased significantly from baseline during pneumoperitoneum in the control group but not in the intervention group. Nevertheless, the changes in partial pressures of oxygen did not differ between groups. Compliance of the respiratory system (CRS) significantly decreased and driving pressure significantly increased during pneumoperitoneum in both groups. However, the changes in CRS and driving pressure were significantly less in the intervention group. Transpulmonary pressure during expiration was maintained in the intervention group while it decreased significantly in the control group.ConclusionPEEP setting guided by Poeso measurement showed no beneficial effects in terms of oxygenation but respiratory mechanics were better during laparoscopic gynaecological surgery.Trial RegistrationClinicalTrials.gov identifier: NCT03256396.

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