Best Respiratory Compliance Following a Recruitment Maneuver Allows Hemodynamically Stability During Laparoscopic Surgery: a Secondary Analysis of a Randomized Controlled Trial

Abstract Background Strategies involving positive end-expiratory pressure (PEEP) and alveolar recruitment maneuvers (RMs) aim to provide better respiratory mechanics and prevent atelectasis but may have adverse cardiovascular effects. We hypothesized that individualized PEEP to best lung compliance should be hemodynamically well tolerated as it restores normal lung volumes in patients undergoing laparoscopic surgery. Methods This study analyzed the cardiovascular effects of individualized PEEP in laparoscopic surgery patients. Cardiac index [CI], mean arterial pressure [MAP], heart rate [HR], stroke volume variation [SVV] changes were recorded and analyzed during RMs and decremental PEEP trials. Results Sixty-four patients were enrolled in this study. Our findings revealed that the hemodynamic effects, including reduction in CI (p < 0.001), MAP (p < 0.001), and increase in SVV (p < 0.001), were transient and not associated with vasopressors requirement. Receiver Operating Characteristic (ROC) analysis demonstrated that PEEP levels above 17 cmH2O significantly affected CI (Area Under the ROC Curve = 0.638), while post-hoc analysis from ANOVA indicated that PEEP levels below 16 cmH2O had minimal impact on CI (p < 0.001). Notably, individualized PEEP levels led to decreased CI in 10 (16%) patients and decreased MAP in 11 (17%) patients. Mixed effects modeling showed that age negatively influenced MAP (Estimate = -0.207, p = 0.010). Conclusion RMs and decremental PEEP trials transiently affect hemodynamics such as CI, MAP and SVV, and age negatively influencing MAP. PEEP levels below 16 cmH2O had minimal impact on hemodynamics. Notably, individualized PEEP levels do not guarantee consistent hemodynamic stability across all individuals. Study URL: https://www.chictr.org.cn/showproj.html?proj=123129 Date of the study first posted on ChiCTR.org.cn: Apr 7th, 2021 Date of enrolment of the first research participant: May 6th, 2021