Obez hastalarda pron pozisyonda PEEP uygulamasının solunum mekanikleri, intraabdominal basınç ve hemodinami üzerine etkileri

Abstract

Amaç: Amacımız pron pozisyonda cerrahi geçirecek obezlerde farklı seviyelerde ekspirasyon sonu pozitif basınç (PEEP) uygulamalarının solunum mekanikleri, hemodinami ve intraabdominal basınç üzerine etkilerini araştırmaktır. Hastalar ve Yöntem: Pron pozisyonda, batın dışı operasyon geçirecek olan, vücut kitle indeksi (VKİ) 30 ve üzeri 54 hasta çalışmaya alındı. Hastalar 3 gruba randomize edildi. PEEP Grup 1’de 0 cmH2O, Grup 2‘de 5 cmH2O, Grup 3’de 10 cmH2O olarak ayarlandı. Pron çevirmeden hemen önce supin pozisyonunda ve pron pozisyonunda kan gazı örnekleri alındı. Kalp tepe atımı(KTA), sistolik arter basıncı(SAB), diastolik arter basıncı (DAB), ortalama arter basıncı (OAB) ve dinamik kompliyans, Pozitif inspiratuar basınç (PIP), plato basınç (Pplato) , solunum sonu karbondioksit basıncı(PetCO2), oksijen saturasyonu(SpO2), tidal volüm (VT) kaydedildi. İntrabdominal basınç ölçümü (İAB) yapıldı. Prondan supin pozisyonuna döndürüldükten sonra ölçümler tekrarlanarak kaydedildi. Bulgular: Supin dönem ile karşılaştırıldığında pron dönemde ölçülen kompliyans, SAB, DAB, OAB, KTA, PetCO2 değerleri her üç grupta da istatistiksel olarak anlamlı düşük saptandı [p değeri sırasıyla; (p =0,02) (p =0,018) (p =0,013) (p =0,002) p =0,02) (p =0,01) ]. Supin dönem ile karşılaştırıldığında pron dönemde ölçülen PIP ve Pplato değerleri istatistiksel olarak anlamlı daha yüksek saptandı (p=0,002) ve (p=0,001). Gruplar arası ikili karşılaştırmada Grup 3 de PIP ve Pplato değerleri Grup 1 e göre anlamlı yüksek saptandı (p =0,002), (p =0,001). Sonuç: Pron pozisyonda cerrahi girişim geçirecek hastalarda fizyolojik PEEP uygulamasının yararlı olacağı, özellikle VKİ yüksek hastalarda pron pozisyonun intraabdominal basıncta anlamlı artışa sebep olmadığı ve hemodinamiyi olumsuz etkilmediği ayrıca fizyolojik sınırlarda PEEP uygulamasının oksijenlenmeyi iyileştirebileceği sonucuna varılmıştır.

Keywords

• pron pozisyon
• obezite
• solunum mekaniği
• intraabdominal basınç
• hemodinami

Effects of PEEP on respiratory mechanics, intraabdominal pressure and hemodynamics during prone positioning in obese patients

Abstract

Objective: The aim of our study was to investigate effects of end-expiratory positive pressure (PEEP) at varying degrees on respiratory mechanics, hemodynamic and intra-abdominal pressure in obese patients undergoing surgical intervention at prone position. Patients and method: The study included 54 patients with BMI (Body Mass Index) ≥30 kg/m2 who were scheduled for extra-abdominal surgery at prone position. The patients were randomly assigned into 3 groups as follows: PEEP was set to 0 cmH2O in group 1; 5 cmH2O in group 2; and 10 cmH2O in group 3. The blood gas sampling was performed at supine position immediately before placing patient to prone position and prone position. Heart rate (HR),systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) dynamical compliance, peak inspiratory pressure (PIP), plateu pressure (Pplateu), end tidal carbondioxide pressure (PETCO2), oxygen saturation (SpO2), tidal volume (VT) were recorded. Simultaneously, intra-abdominal pressure was measured. Measurements were repeated after patient placed into supine position from prone position. Findings: When compared to supine period, compliance, SAP, DAP, MAP, HR and PETCO2 values measured at prone period were found to be significantly higher in all groups (p=0,02; p=0,018; p=0,013; p=0,002; p=0,02; p=0,01, respectively) When compared to supine period, PIP and Pplateu values measured at prone period were found to be significantly higher (p=0,002 and p=0,001, respectively). In binary comparisons, PIP and Pplateu values were found to be significantly higher in group 3 than group 1 (p=0,002 and p=0,001, respectively). Conclusion: It was concluded that physiological PEEP administration will be beneficial in patients undergoing surgery at prone position; that it did not cause significant increase in intra-abdominal pressure and negatively affect hemodynamic, particularly in patients with high BMI; and that PEEP in physiological range improved oxygenation.

Keywords

• prone position
• obesity
• respiratory mechanics
• intra-abdominal pressure
• hemodynamic

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