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- DOI 10.18231/j.ijca.2025.068
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CrossMark
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:
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Vishali Ravi Shankar
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Anand Pushparani *
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Iswarya Sankar
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Shaheen Khan
Vishali Ravi Shankar
Anand Pushparani *
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.
References
- Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME. Debas HT. DCP3 Essential surgery author group essential surgery: key messages from disease control priorities. Lancet. 2015;385(9983):2209–19.
- Saraswat V. Effects of anaesthesia techniques and drugs on pulmonary function. Indian J Anaesth. 2015;59(9):557–64.
- Hedenstierna G, Edmark L. Effects of anesthesia on the respiratory system. Best Pract Res Clin Anaesthesiol. 2015;29(3):273–84.
- Hayden P, Cowman S. Anaesthesia for laparoscopic surgery. Contin Educ Anaesth Crit Care Pain. 2011;11(5):177–80.
- Bajwa SJ, Kulshrestha A. Anaesthesia for laparoscopic surgery: General vs regional anaesthesia. J Min Access Surg. 2016;12(1):4–
- Civraz AZ, Saracoglu A, Saracoglu KT. Evaluation of the effect of pressure-controlled ventilation-volume guaranteed mode vs. volume-controlled ventilation mode on atelectasis in patients undergoing laparoscopic surgery: a randomized controlled clinical trial. Medicina. 2023;59(10):1783.
- Li X, Liu H, Wang J, Ni ZL, Liu ZX, Jiao JL, et al. Individualized positive end-expiratory pressure on postoperative atelectasis in patients with obesity: a randomized controlled clinical trial. Anesthesiology. 2023;139(3):262–73.
- Zimatore C, Algera AG, Botta M, Pierrakos C, Serpa Neto A, Grasso S, et al. Lung ultrasound to determine the effect of lower vs. higher peep on lung aeration in patients without ARDS-A substudy of a randomized clinical trial. Diagnostics (Basel). 2023;13(12):1989.
- Todur P, Care SC, Care VA, Srikant N, Prakash P. Correlation of oxygenation and radiographic assessment of lung edema (RALE) score to lung ultrasound score (LUS) in acute respiratory distress syndrome (ARDS) patients in the intensive care unit. Can J Respir Ther. 2021;57:53–9.
- Smit MR, Hagens LA, Heijnen NF, Pisani L, Cherpanath TG, Dongelmans DA, et al. Lung ultrasound prediction model for acute respiratory distress syndrome: a multicenter prospective observational study. Am J Respir Crit Care Me d. 2023;207(12):1591–601.
- Curry S, Tan A, Gargani L, Ng O, Roscoe A, Salaunkey K, et al. Lung ultrasound and the role of lung aeration score in patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation. Int J Artif Organs. 2021;44(11):854–60.
- Pereira SM, Tucci MR, Morais CC, Simões CM, Tonelotto BF, Pompeo MS, et al. Individual positive end-expiratory pressure settings optimize intraoperative mechanical ventilation and reduce postoperative atelectasis. Anesthesiology. 2018;129(6):1070–81.
- Speidel V, Conen A, Gisler V, Fux CA, Haubitz S. Lung assessment with point-of-care ultrasound in respiratory coronavirus disease (COVID-19): a prospective cohort study. Ultrasound Med Biol. 2021;47(4):896–901.
- Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med. 2019;199(6):701–14.
- Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, et al. New international guidelines and consensus on the use of lung ultrasound. J Ultrasound Med. 2023;42(2):309–44.
- Kundra P, Subramani Y, Ravishankar M, Sistla SC, Nagappa M, Sivashanmugam T. Cardiorespiratory effects of balancing PEEP with intra-abdominal pressures during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutaneous Tech. 2014;24(3):232–9.
- Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. J Min Access Surg. 2010;6(4):91–4.
- Östberg E, Thorisson A, Enlund M, Zetterström H, Hedenstierna G, Edmark L. Positive end-expiratory pressure and postoperative atelectasis: a randomized controlled trial. Anesthesiology. 2019;131(4):809–17.
- Atashkhoei S, Yavari N, Zarrintan M, Bilejani E, Zarrintan S. Effect of different levels of positive end-expiratory pressure (PEEP) on respiratory status during gynecologic laparoscopy. Anesthesiol Pain Med. 2020;10(2)\:e100075.
- Szabó M, Bozó A, Darvas K, Soós S, Őzse M, Iványi ZD. The role of ultrasonographic lung aeration score in the prediction of postoperative pulmonary complications: an observational study. BMC Anesthesiol. 2021;21:19.
- Meininger D, Byhahn C, Mierdl S, Westphal K, Zwissler B. Positive end‐expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum. Acta Anaesthesiol Scand. 2005;49(6):778–83.
- Abedinzade M, Taghavi N, Farsani NM. Evaluation of the effects of gradual increases in intra-abdominal pressure on blood pressure in a patient undergoing laparoscopic cholecystectomy. 2024;10.21203/rs.3.rs-4601648/v1
[Google Scholar] - Atashkhoei S, Yavari N, Zarrintan M, Bilejani E, Zarrintan S. Effect of different levels of positive end-expiratory pressure (PEEP) on respiratory status during gynecologic laparoscopy. Anesthesiol Pain Med. 2020;10(2)\:e100075.
- Kim BR, Lee S, Bae H, Lee M, Bahk JH, Yoon S. Lung ultrasound score to determine the effect of fraction inspired oxygen during Shankar et al. / Indian Journal of Clinical Anaesthesia 2025;12(3):434–441 441 alveolar recruitment on absorption atelectasis in laparoscopic surgery: a randomized controlled trial. BMC Anesthesiol. 2020;20:1–1.
- Deeparaj L, Kumar R, Patel N, Ayub A, Rewari V, Subramaniam R, et al. Effect of lung compliance-based optimum pressure versus fixed positive end-expiratory pressure on lung atelectasis assessed by modified lung ultrasound score in laparoscopic gynecological surgery: A prospective randomized controlled trial. Cureus. 2023;15(6):e40278.