Effects of intraoperative inverse ratio ventilation on postoperative pulmonary function tests in the patients undergoing laparoscopic cholecystectomy

Abstract

Background and Aims: Induction of general anaesthesia is associated with development of atelectasis in the lungs, which may further lead to postoperative pulmonary complications. Inverse ratio ventilation (IRV) has shown to improve oxygenation and minimise further lung injury in patients with acute respiratory distress syndrome. We evaluated the safety and effectiveness of IRV on intraoperative respiratory mechanics and postoperative pulmonary function tests (PFTs). Methods: In a prospective, controlled study, 128 consecutive patients with normal preoperative PFTs who underwent elective laparoscopic cholecystectomy were randomised into IRV and conventional ventilation groups. Initially, all patients were ventilated with settings of tidal volume 8 mL/kg, respiratory rate 12/min, inspiratory/expiratory ratio (I: E) = 1:2, positive end expiratory pressure = 0. Once the pneumoperitoneum was created, the conventional group patients were continued to be ventilated with same settings. However, in the IRV group, I: E ratio was changed to 2:1. Peak pressure (Ppeak), Plateau pressure (Pplat) and lung compliance were measured. Haemodynamic parameters and arterial blood gas values were also measured. PFTs were repeated in postoperative period. Statistical tool included Chi-square test. Results: There was no significant difference in PFTs in patients who underwent IRV as compared to conventional ventilation [forced vital capacity (FVC) 2.52 ± 0.13 versus 2.63 ± 0.16, P = 0.28]. The Ppeak (cmH2O) and Pplat (cmH2O) were statistically lower in IRV patients [Ppeak 21.4 ± 3.4 versus 22.4 ± 4.2, P = 0.003] [Pplat 18.7 ± 2.4 versus 19.9.4 ± 3.2, P = 0.008]. There was no significant difference in lung compliance and oxygenation intraoperatively. Conclusion: Intraoperative IRV led to reduced airway pressures; however, it did not prevent deterioration of PFTs in postoperative period.

The effect of inverse ratio ventilation on cardiopulmonary function in obese laparoscopic surgery patients: A systematic review and meta-analysis

“…However, the results of Adabala et al . [ 9 ] showed that despite the improvement of respiratory mechanics indices by IRV, these did not prevent the deterioration of postoperative pulmonary function. In the study by Hur et al .,[ 10 ] it was concluded that prolonged inspiratory time did not have a significant effect on respiratory mechanics, so there is a lack of certainty as to whether IRV has positive implications.…”