The effect of two different tidal volume on ventilation distribution in living donor laparoscopic nephrectomy using electrical impedance tomography: A single-blind randomized clinical trial
Abstract Background: The laparoscopic technique causes physiological alterations to the respiratory system due to body positions and pneumoperitoneum. This trial compares the effects of lateral position and pneumoperitoneum between tidal volume (TV) of 6 mL/kg predicted body weight and 10 mL/kg on v...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-04-01
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| Series: | Bali Journal of Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.4103/bjoa.bjoa_14_24 |
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| Summary: | Abstract Background: The laparoscopic technique causes physiological alterations to the respiratory system due to body positions and pneumoperitoneum. This trial compares the effects of lateral position and pneumoperitoneum between tidal volume (TV) of 6 mL/kg predicted body weight and 10 mL/kg on ventilation distribution using electrical impedance tomography (EIT) in patients undergoing transperitoneal laparoscopic donor nephrectomy. Materials and Methods: A single-blind, randomized clinical trial was conducted on 30 patients who were assigned to the group receiving an intraoperative TV of 6 mL/kg (VT-6) or 10 mL/kg (VT-10) during laparoscopic nephrectomy surgery. The tidal impedance variation (TIV), delta end-expiratory lung impedance (ΔEELI), and regional compliance (CR) were recorded during the anesthesia period using EIT. Data were analyzed with Student t test and Mann–Whitney U test for comparison between the two groups, while two-way analysis of variance or Friedman test with post hoc analysis was used to compare different time points. Results: ΔTIV changed significantly in five phases of positioning and insufflation during laparoscopic nephrectomy surgery in the dependent lung region in both groups, but it was higher in the VT-6 group (P = 0.015). ΔEELI was greater in both the dependent and non-dependent lung regions in VT-10 group (P = 0.043 and 0.014, respectively). The CR in the lung-dependent region between VT-6 and VT-10 showed significant differences in the lateral post-intubation (P = 0.022) and 15 min of insufflation positions (P = 0.005). Conclusion: VT-10 showed a more homogeneous demonstration of better ventilation distribution and tidal recruitment than VT-6, but with potential risks of lung overdistension and reduced compliance. |
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| ISSN: | 2549-2276 |