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Background: Managing ventilation and oxygenation during laparoscopic bariatric procedures in morbidly obese patients represents many challenges. Aim of the Work: To compare the effect of these modes of ventilation on respiratory parameters in obese patients undergoing laparoscopic bariatric surgeries and whether this influences the need of postoperative ventilation or not Patients and Methods: After approval of ethical committee of faculty of Medicine Ain Shams University and obtaining an informed consent from every patient, this randomized controlled clinical trial study was conducted at Ain Shams University Hospitals operating theatre department on 40 obese adult patients of ASA physical status I-II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic bariatric surgery. General anesthesia with endotracheal intubation and controlled ventilation was conducted in all patients. Patients were divided randomly into two equal groups: Group A; received volume controlled ventilation and Group B; received pressure controlled ventilation. Results: The study found no significant difference between the two groups as regards PaO2 and PaO2:FiO2 preoperatively, after pneumoperitonium, at the end of surgery and postoperatively. As regards PaCO2 there was no statistically significant difference between the two groups in the preoperative measurement while there was statistically highly significant difference between the two groups after pneumoperitonium, at the end of surgery and postoperatively with lower PaCO2 in group (B) that received PCV than group (A) that received VCV. There was statistically highly significant difference between the two groups as regards dynamic compliance after intubation, after pneumoperitonium and at the end of the surgery with higher dynamic compliance in group (B) that received PCV. The results showed no statistically significant difference between the two studied groups regarding the need of post-operative ventilation. Conclusion: No significant difference between pressure controlled ventilation and volume controlled ventilation regarding oxygenation and the need of postoperative ventilation but PaCo2 levels are lower and dynamic compliance is higher with pressure controlled ventilation.

Background Pneumothorax (PTX) is an emergency that requires urgent management to avoid catastrophic consequences. PTX is also an important cause of respiratory failure in the emergency department, and may occur frequently as a complication of central venous catheter insertion. Aim The aim of this study is to compare the diagnostic accuracy of bedside lung US with those for anteroposterior (AP) chest X ray (CXR) for the detection of PTX in critically ill patients. Methods This study was conducted on fifty adult patients from both sexes, mechanically ventilated at least 48 hours and planned for central line insertion. We excluded overt pneumothorax, patients requiring immediate invasive intervention, pregnancy and lactation. Lung ultrasound was done to all patients after 30 minutes from central line insertion followed by CXR to confirm the diagnosis of pneumothorax. Pneumothorax was confirmed using CT chest. Results Results showed that ultrasound is superior to chest X Ray in detection of PTX.Ultrasound showed sensitivity of 94.87%, specificity of 81.82%, positive predictive value of 94.87%, negative predictive value of 21.82% and accuracy of 92.0% in detection of PTX, while Chest X Ray showed sensitivity of 76.92%, specificity of 63.64%, positive predictive value of 88.24%, negative predictive value of 43.75% and accuracy of 74.0% in detection of PTX. Conclusions In conclusion, US represent a good approach for the evaluation of PTX, with advantages of timeliness, high accuracy and high reliability.