Repercussions of pneumoperitoneum for laparoscopic cholecystectomy on mechanical power with volume-controlled ventilation

Claudio Luciano Franck, Letícia Lopes Machado, Felipe Lopes de Moraes Pironatto, Rodrigo Soares

Abstract

Background

The installation of pneumoperitoneum alters mechanical ventilation mechanics, which can lead to an increase in mechanical power and lead to Ventilator-Induced Lung Injury (VILI) and postoperative pulmonary complications and reintubation. Aim: To analyse the repercussions of pneumoperitoneum on mechanical power during general anaesthesia for cholecystectomy, verify changes in the parameters of the components of ventilatory mechanics and their repercussions on mechanical power before, during and after pneumoperitoneum emptying.

Methods

Analytical, cross-sectional and observational study carried out between 2022 and 2023, in Sixty patients undergoing general anaesthesia for video laparoscopic cholecystectomy. The parameters of the components of the ventilatory mechanics were collected, such as RR, VT, Ppeak, Plateau, PEEP, ΔP, resistance and compliance, and the mechanical power during the intraoperative period, ten minutes before the pneumoperitoneum was performed, during the pneumoperitoneum and ten minutes after the pneumoperitoneum. When the hypothesis of equality of means in the three evaluation moments was rejected, these moments were compared two by two considering the LSD test. P < 0.05 indicated statistical significance.

Results

The variables RR, Pplateau, ∆P, and compliance showed significant differences in three-by-three comparisons (P < 0.001) but not PEEP (P = 0.217) and VT (P = 0.338). The parameters Ppeak, resistance and mechanical power, in addition to presenting significant differences in the three-by-three comparisons (P < 0.001) also presented significant differences in the two-by-two comparison before and during, before and after, during and after the pneumoperitoneum.

Conclusion

Pneumoperitoneum during cholecystectomy surgery resulted in an increase in mechanical power above values considered protective during volume-controlled ventilation, due to reduced compliance and increased resistance, which tend to normalize after emptying.

Keywords: mechanical ventilation; mechanical power; video laparoscopy; pneumoperitoneum

References

1. Wazir JS, Gupta AK, Mushtaq U, et al. Pulmonary function changes in patients undergoing laparoscopic cholecystectomy. International Surgery Journal 2022; 9(5):1052. https://doi.org/10.18203/2349-2902.isj20221154

2. Hasan AF, Haider HS, Comparison between volume controlled ventilation and pressure controlled ventilation in laparoscopic cholecystectomy and their effects on hemodynamic and respiratory parameters. Medico-legal Update 2023; 23(1):7-14. https://doi.org/10.37506/mlu.v23i1.3354

3. González-Bermejo LL, Pozo-Romero JA, Correa-Borrell, CM. Comportamiento de presiones intrapulmonares con inversión de la relación inspiración espiración en colecistectomía laparoscópica. Rev Mex Anestesiol 2022; 45(1):16-22. https://doi.org/10.35366/102898

4. Silva PL, Ball L, Rocco PRM, et al. Physiological and pathophysiological consequences of mechanical ventilation. Semin Respir Crit Care Med 2022; 43(3):321-334. https://doi.org/10.1055/s-0042-1744447 PMid:35439832

5. Brochard L, Bersten A. Mechanical Power. Anesthesiology 2019; 130(1):9-11. https://doi.org/10.1097/ALN.0000000000002505 PMid:30383544

6. Maia LA, Samary CS, Oliveira MV, et al. Impact of different ventilation strategies on driving pressure, mechanical power, and biological markers during open abdominal surgery in rats. Anesth Analg 2017; 125(4):1364-1374. https://doi.org/10.1213/ANE.0000000000002348 PMid:28759484

7. Papazian L, Aubron C, Brochard L, et al. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care 2019; 9(1):69. https://doi.org/10.1186/s13613-019-0540-9 PMid:31197492 PMCid:PMC6565761

8. Ward J, Noel C. Basic modes of mechanical ventilation. Emerg Med Clin North Am 2022 Aug;40(3):473-88. https://doi.org/10.1016/j.emc.2022.05.003 PMid:35953212

9. Dianti J, Matelski J, Tisminetzky M, et al. Comparing the effects of tidal volume, driving pressure, and mechanical power on mortality in trials of lung-protective mechanical ventilation. Respir Care 2020; 66(2):221-227. https://doi.org/10.4187/respcare.07876 PMid:32843513

10. Jo YY, Chang YJ, Lee D, et al. Comparisons of mechanical power and respiratory mechanics in pressure-controlled ventilation and volume-controlled ventilation during laparoscopic cholecystectomy in elderly patients. J Pers Med 2023; 13(2):201. https://doi.org/10.3390/jpm13020201 PMid:36836435 PMCid:PMC9967818

11. Junior LCMC, Bezen BAMP. Respiratory monitoring – respiratory mechanics. In: Azevedo LCP, Taniguchi LU, Ladeira Jp. et al. Intensive care medicine: practical approach. 5th ed. Barueri: Manole, 2022:735.

12. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive care medicine 2016; 42(10):1567-1575. https://doi.org/10.1007/s00134-016-4505-2 PMid:27620287

13. Romitti F, Busana M, Palumbo MM, et al. Mechanical power thresholds during mechanical ventilation: An experimental study. Physiol Rep 2022; 10(6):e15225. https://doi.org/10.14814/phy2.15225 PMid:35340133 PMCid:PMC8957661

14. Chiumello D, Gotti M, Guanziroli M, et al. Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation. Crit Care 2020; 24(1):417. https://doi.org/10.1186/s13054-020-03116-w PMid:32653011 PMCid:PMC7351639

15. Cressoni M, Gotti M, Chiurazzi C, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology 2016; 124(5):1100-1108. https://doi.org/10.1097/ALN.0000000000001056 PMid:26872367

16. Buiteman-Kruizinga LA, Mkadmi HE, Schultz MJ, et al. Comparison of mechanical power during adaptive support ventilation versus nonautomated pressure-controlled ventilation-A pilot study. Crit Care Explorations 2021; 3(2):e0335. https://doi.org/10.1097/CCE.0000000000000335 PMid:33604578 PMCid:PMC7886404

17. Karalapillai D, Weinberg L, Neto AS, et al. Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients. Eur J Anaesthesiol 2021; 39(1):67-74. https://doi.org/10.1097/EJA.0000000000001601 PMid:34560687 PMCid:PMC8654268

18. Toker MK, Altıparmak B, Uysal Aİ, et al. Comparison of pressure-controlled volume-guaranteed ventilation and volume-controlled ventilation in obese patients during gynecologic laparoscopic surgery in the Trendelenburg position. Braz J Anesthesiol 2019; 69(6):553-560. https://doi.org/10.1016/j.bjan.2019.09.003 PMid:31836201 PMCid:PMC9391862

19. Bogár L, Domokos K, Csontos C, et al. The Impact of pneumoperitoneum on mean expiratory flow rate: observational insights from patients with healthy lungs. Diagnostics (Basel) 2024; 14(21):2375. https://doi.org/10.3390/diagnostics14212375 PMid:39518343 PMCid:PMC11544817

20. Koca E. Evaluation of plethysmographic variability index and hemoglobin monitoring in patients who underwent laparoscopic cholecystectomy. Eur Rev Med Pharmacol Sci 2022; 26(13):4762-4769.

21. Inal FY, Camgoz YY, Hayrettin Daskaya, et al. Comparison of the effects of volume-controlled ventilation and pressure-controlled ventilation modes on hemodynamics, respiratory mechanics and blood gas parameters in patients undergoing laparoscopic cholecystectomy. International Journal of Advances in Medicine 2021; 8(9):1267-1273. https://doi.org/10.18203/2349-3933.ijam20213172

22. Shaji U, Jain G, Tripathy DK, et al. Influence of intra-abdominal pressure on ventilatory mechanical power delivery and respiratory driving pressure during laparoscopic cholecystectomy: A prospective cohort study. J Anaesthesiol Clin Pharmacol 2024;4 0(3):516-522. https://doi.org/10.4103/joacp.joacp_45_23 PMid:39391650 PMCid:PMC11463922

23. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med 2010; 181(6):578-586. https://doi.org/10.1164/rccm.200905-0787OC PMid:19910610