Bireyselleştirilmiş PEEP Laparoskopik Histerektomi Sonrası Pulmoner Sonuçları İyileştirir: Prospektif Randomize Çalışma

Öz

Amaç: Laparoskopik cerrahi sırasında uygulanan Trendelenburg pozisyonu ve pnömoperitoneum, solunum mekaniğini olumsuz etkileyerek postoperatif pulmoner komplikasyon (PPK) riskini artırabilir. Bu çalışmada, laparoskopik total histerektomi uygulanan hastalarda bireyselleştirilmiş pozitif ekspirasyon sonu basıncı (PEEP) stratejisinin, konvansiyonel sabit PEEP uygulamasına kıyasla intraoperatif solunumsal parametreler ve postoperatif pulmoner komplikasyonlar üzerindeki etkilerinin değerlendirilmesi amaçlandı. Materyal ve Metot: Bu prospektif, randomize kontrollü çalışmaya ASA fiziksel durum sınıfı I–III olan 113 hasta dahil edildi. Hastalar bireyselleştirilmiş PEEP grubu (PEEPᵢ, n=56) ve sabit 5 cmH₂O PEEP grubu (PEEP₅, n=57) olmak üzere iki gruba randomize edildi. PEEPᵢ grubunda optimal PEEP düzeyi, dinamik kompliyans rehberliğinde uygulanan basamaklı rekruitman manevrası ile belirlendi. Birincil sonlanım noktası, postoperatif ilk 7 gün içinde gelişen PPK insidansıydı. İkincil sonlanım noktaları arasında oksijen gereksinimi, CPAP veya mekanik ventilasyon gereksinimi ve hastanede kalış süresi yer aldı. Bulgular: PEEPᵢ grubunda belirlenen optimal PEEP değeri 14 cmH₂O (IQR: 10–14) idi. Postoperatif pulmoner komplikasyon insidansı, PEEP₅ grubuna kıyasla PEEPᵢ grubunda anlamlı olarak daha düşüktü (%7,7’ye karşı %34,7; p=0,001). Dinamik kompliyans PEEPᵢ grubunda daha yüksek, sürücü basınç ise anlamlı olarak daha düşüktü (p<0,001). Her iki grupta da ciddi postoperatif pulmoner komplikasyon gözlenmedi. Sonuç: Hastaya özgü solunum mekaniği temelinde belirlenen bireyselleştirilmiş PEEP uygulaması, laparoskopik jinekolojik cerrahi sırasında intraoperatif oksijenasyonu ve solunum mekaniğini iyileştirmekte, ayrıca postoperatif pulmoner komplikasyon insidansını azaltmaktadır. Kişiselleştirilmiş ventilasyon stratejileri, klinik sonuçların iyileştirilmesi ve ventilatör ilişkili akciğer hasarının azaltılması amacıyla perioperatif ventilasyon yönetiminde göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Bireyselleştirilmiş PEEP
• dinamik kompliyans
• postoperatif pulmoner komplikasyon
• laparoskopik histerektomi
• sürücü basıncı

Proje Numarası

2022/394

Individualized PEEP Improves Pulmonary Outcomes After Laparoscopic Hysterectomy: A Prospective Randomized Study

Öz

Objective: Trendelenburg positioning and pneumoperitoneum during laparoscopic surgeries can impair pulmonary function and increase the risk of postoperative pulmonary complications (PPCs). This study aimed to investigate the effects of individualized positive end-expiratory pressure (PEEP) on respiratory parameters and PPCs compared to conventional PEEP strategies in patients undergoing laparoscopic total hysterectomy. Materials and Methods: In this prospective, randomized controlled trial, 113 patients with ASA physical status I–III were randomized into two groups: individualized PEEP group (PEEPᵢ, n=56) and fixed PEEP 5 cmH₂O group (PEEP₅, n=57). Optimal PEEP in the PEEPᵢ group was determined via a stepwise recruitment maneuver guided by dynamic compliance. The primary endpoint was the incidence of PPCs within the first 7 postoperative days. Secondary endpoints included oxygen requirement, CPAP or mechanical ventilation use, and length of hospital stay. Results: The mean optimal PEEP in the PEEPᵢ group was 14 cmH₂O (IQR: 10–14). The incidence of PPCs was significantly lower in the PEEPᵢ group compared to PEEP₅ (7.7% vs. 34.7%, p=0.001). Dynamic compliance was higher and driving pressure significantly lower in the PEEPᵢ group (p<0.001). No severe postoperative pulmonary events occurred in either group. Conclusion: Individualized PEEP based on patient-specific respiratory mechanics significantly improves intraoperative oxygenation and reduces the incidence of PPCs in laparoscopic gynecological surgery. Personalized ventilation strategies should be considered to enhance clinical outcomes and minimize ventilator-induced lung injury.

Anahtar Kelimeler

• Individualized PEEP
• dynamic compliance
• postoperative pulmonary complication
• laparoscopic hysterectomy
• driving pressure

Proje Numarası

2022/394

Kaynakça

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