Comparing effects of different levels of positive end-expiratory pressure on aeration score in laparoscopic surgeries using lung ultrasound: A randomised controlled trial

• Author Details:   
• Vishali Ravi Shankar
• Anand Pushparani ^*
• Iswarya Sankar
• Shaheen Khan

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Background and Aims: Laparoscopic surgeries can lead to pulmonary atelectasis due to pneumoperitoneum and Trendelenburg positioning, affecting respiratory function. Positive end-expiratory pressure (PEEP) is used to improve lung aeration, but the optimal PEEP level remains unclear. Lung ultrasound (LUS) provides a non-invasive method to assess lung aeration. This study was aimed to compare different levels of PEEP (0, 5 and 10 cm H₂O) using lung ultrasound scores in patients undergoing laparoscopic surgeries.

Materials and Methods: A randomized controlled trial with 120 patients undergoing laparoscopic surgeries. Patients were allocated into three groups: PEEP 0, PEEP 5 and PEEP 10. Lung ultrasound score (LUSS) was assessed preoperatively and postoperatively at 10, 30 and 60 minutes. Hemodynamic parameters and end tidal CO₂ were monitored.

Results: PEEP 5 maintained stable hemodynamics with significantly less atelectasis compared to PEEP 0 and PEEP 10. Mean LUSS was significantly lower in PEEP 5 (mean ±SD 7.5±2.1) compared to PEEP 0 (15.3±2.9) and PEEP 10 (8.1±2.6) (p<0>

Conclusion: This study concludes that a PEEP of 5 is optimal for minimizing postoperative atelectasis, as indicated by the Lung Ultrasound Score (LUSS), while also ensuring hemodynamic stability during laparoscopic surgeries.

Keywords: Positive end-expiratory pressure (PEEP), Lung ultrasound score (LUSS), Laparoscopic surgery, Pulmonary atelectasis, Pneumoperitoneum.