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Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

ABSTRACT: Introduction:The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated. Aim:To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP. Material and methods:Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this study. Group 1 included patients who received the PRM at a maximum pressure of 30-40 cm H2O in a semi-Fowler position and group 2 included patients who received the PRM at a maximum pressure of 15 cm H2O in a semi-Fowler position. The primary outcome of the study was the difference in PLSP between the two groups. Results:There were no significant differences in PLSP and wound pain VAS scores between patients receiving the PRM at 30 cm H2O and 15 cm H2O during postoperative pain monitoring (p < 0.05). The groups were also similar with respect to ambulation time (p = 0.215), length of hospital stay (p = 0.556) and the height of the pneumoperitoneum measured on chest X-ray (p = 0.151). Conclusions:The low-pressure PRM (15 cm H2O pressure) provides similar efficacy as the moderate-pressure PRM (30-40 cm H2O) in terms of PLSP, wound pain, height of pneumoperitoneum, time of ambulation and length of hospital stay. We suggest that lower maximal inspiratory pressure of 15 cm H2O might be preferred to avoid the potential complications of the PRM with higher pressures.

SUBMITTER: Yilmaz G

PROVIDER: S-EPMC7457197 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

Yilmaz Gulseren G Kiyak Huseyin H Akca Aysu A Salihoglu Ziya Z

Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques 20191118 3

<h4>Introduction</h4>The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-laparoscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated.<h4>Aim</h4>To compare the efficacy of the low-pressure PRM with moderate-pressure PRM in preventing PLSP.<h4>Material and methods</h4>Seventy-two ASA I-II patients who were scheduled for gynecologic LS for non-malignant conditions were enrolled in this stu ...[more]

PMID: 32904585

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Project description:BackgroundPulmonary atelectasis in anesthetized children is easily reverted by lung recruitment maneuvers. However, the high airways pressure reached during the maneuver could negatively affect hemodynamics. The aim of this study is to assess the effect and feasibility of a postural lung recruitment maneuver (P-RM); i.e., a new maneuver that opens up the atelectatic lung areas based on changing the child's body position under constant ventilation with moderated driving pressure (12 cmH2O) and of positive end-expiratory pressure (PEEP, 10 cmH2O). Forty ASA I-II children, aged 6 months to 7 years, subjected to general anesthesia were studied. Patients were ventilated with volume control mode using standard settings with 5 cmH2O of PEEP. They were randomized into two groups: (1) control group (C group, n = 20)-ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH2O. PEEP was increased from 5 to 10 cmH2O during 3 min maintaining the supine position. (2) P-RM group (n = 20)-patients received the same increase in driving pressure and PEEP, but they were placed, respectively, in the left lateral position, in the right lateral position (90 s each), and back again into the supine position after 3 min. Then, ventilation returned to baseline settings in volume control mode. Lung ultrasound-derived aeration score and respiratory compliance were assessed before (T1) and after (T2) 10 cmH2O of PEEP was applied.ResultsAt baseline ventilation (T1), both groups showed similar aeration score (P-RM group 9.9 ± 1.9 vs C group 10.4 ± 1.9; p = 0.463) and respiratory compliance (P-RM group 15 ± 6 vs C group 14 ± 6 mL/cmH2O; p = 0.517). At T2, the aeration score decreased in the P-RM group (1.5 ± 1.6 vs 9.9 ± 2.1; p < 0.001), but remained without changes in the C group (9.9 ± 2.1; p = 0.221). Compliance was higher in the P-RM group (18 ± 6 mL/cmH2O) when compared with the C group (14 ± 5 mL/cmH2O; p = 0.001).ConclusionLung aeration and compliance improved only in the group in which a posture change strategy was applied.

Dataset Information

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

Publications

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

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