Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials

Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials

Abstract Background High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics. Methods We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 compari...

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Main Authors: Gulfairus A. Yessenbayeva, Aizhan M. Meyerbekova, Sergey I. Kim, Murat B. Zhumabayev, Gulbanu S. Berdiyarova, Sanzhar B. Shalekenov, Dinara S. Zharlyganova, Irina Y. Mukatova, Yekaterina A. Yukhnevich, Dmitriy A. Klyuyev, Andrey I. Yaroshetskiy
Format: Article
Language:English
Published: BMC 2025-02-01
Series:BMC Anesthesiology
Subjects:
Positive end-expiratory pressure
PEEP
Laparoscopic surgery
Lung protective ventilation
Compliance
Oxygenation
Online Access:https://doi.org/10.1186/s12871-025-02933-2
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Summary:Abstract Background High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics. Methods We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0–5 mbar; moderate PEEP (MPEEP): 6–9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied. Results 8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2/FiO2 (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi2 34.92, p < 0.0001; I2 89%). iPEEP vs. LPEEP also increased PaO2/FiO2 + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi2 26.95, p < 0.0001; I2 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi2 93.16, p < 0.0001; I2 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi2 53.92, p < 0.0001; I2 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons. Conclusion In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive. PROSPERO Registration CRD42023488971; registered December 14, 2023.
ISSN:1471-2253

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