Comparison of the Effects of Positive End-Expiratory Pressure and Recruitment Manoeuvre Applied in Laparoscopic Surgeries on Respiratory Mechanics and Arterial Oxygenation: Randomized Clinical Trial

Objective: In patients undergoing mechanical ventilation in laparoscopic surgeries, pulmonary gas exchange and oxygenation are impaired due to many reasons, especially atelectasis. In this study, it was aimed to compare the effects of positive end-expiratory pressure (PEEP) and recruitment practices on respiratory mechanics and oxygenation in patients undergoing laparoscopic surgery. Material and Methods: This prospective study was performed with 60 American Society of Anesthesiologists I-II patients who underwent laparoscopic cholecystectomy. After induction of anaesthesia, the patients were randomly divided into three groups as the patients who were applied +10 cmH2O PEEP during pneumoperitoneum (Group P), patients who were applied 40 cmH2O continuous positive airway pressure (Group S) after desufflation and the control group (Group C). Arterial blood gas values before anesthesia, before insufflation, after insufflation, desufflation and postoperative, respiratory mechanics values during operation [dynamic lung compliance (Cdyn), airway resistance, peak and mean airway pressure] were compared with the relevant time data. Results: While there was a significant decrease in PaO2 in Group C in the post-desufflation period compared to the pre-insufflation period, an increase in PaO2 was observed in both the groups wherein the manoeuvre was applied, especially in Group S. The increase in Group S was significantly higher than Group P. In all postoperative periods, arterial oxygenation values were significantly higher in groups wherein manoeuvre was applied (Group P: p=0.006, p<0.001, p<0.001; Group S: p=0.042, p<0.001, p=0.004). Dynamic compliance values decreased in all groups after insufflation. During the desufflation period, Cdyn values were significantly higher in Group P and especially in Group S compared to Group C (p<0.001). Conclusion: Recruitment manoeuvres are effective and safe in preventing impairment of blood gas and respiratory mechanics in patients undergoing laparoscopic surgery.