The effect of alveolar recruitment maneuver and positive end expiratory pressure on arterial oxygenation and postoperative outcome in morbidly obese patients undergoing laparoscopic reduction gastroplasty

Abstract EN

The aim of this work was to study the effect of the alveolar recruitment maneuver followed by positive end expiratory pressure on gas exchange in morbidly obese patients undergoing laparoscopic reduction gastroplasty and to study its effect on postoperative patient outcome.

Patients and methods This prospective controlled randomized clinical trial was conducted on 40 patients with BMI greater than 40 kg/m2 who underwent laparoscopic reduction gastroplasty under general anesthesia.

The patients were allocated randomly into two equal groups: group I (the control group) included patients whose lungs were ventilated using the standard method and group II (the study group) included patients whose lungs were ventilated as in group I and for whom the lung recruitment maneuver was then performed by inflating the lungs with a positive pressure of 40 cmH2O, maintaining this pressure for 15 s, followed by positive end expiratory pressure of 8 cmH2O.

This was repeated every 10 min throughout the procedure until extubation in the ICU.

At the end of the surgery, all patients were transferred intubated to the ICU until extubation and then transferred to the intermediate care unit for 24 postoperative hours.

Volume of arterial blood gases, mean arterial blood pressure, heart rate, operative time, time to extubation, duration of ICU stay, and the number of patients in need of postextubation ventilatory support were recorded throughout the study.

Results Hemodynamic variables showed no significant difference between the groups.

PaO2 showed a highly significant increase in both groups after intubation, but increase in PaO2 was more significant in group II than in group I.

PaCO2 and pH showed no significant difference between groups.

There was a significant decrease in extubation time and duration of ICU stay in group II patients in comparison with group I.

As regards the postextubation ventilatory support, only one patient in group II needed a postextubation continuous positive airway pressure mask for 1 h, whereas in group I four patients needed a postextubation continuous positive airway pressure mask and one of them required reintubation.

Conclusion Lung recruitment maneuver is a suitable and beneficial technique during recovery in morbidly obese patients with minimal side effects.

It is also beneficial in decreasing the time to extubation and duration of ICU stay.