Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Laparoscopic Bariatric Surgery

Abstract

Intraoperative alveolar recruitment with a VCM followed by PEEP 10 cm H(2)O is effective at preventing lung atelectasis and is associated with better oxygenation, shorter PACU stay, and fewer pulmonary complications in the postoperative period in obese patients undergoing laparoscopic bariatric surgery.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…Ventilation strategies The effects of intraoperative intermittent positive pressure ventilation (IPPV) regimens on physiological variables are reported in bariatric patients [114][115][116][117][118]. Currently, the translation of these data into effects on postoperative pulmonary complications and outcomes is lacking for the bariatric population.…”

Perioperative management of the severely obese patient: a selective pathophysiological review

“…Positive end-expiratory pressure values of 10 cm H 2 O applied after recruitment/vital capacity maneuvers produce a lower A-a gradient than the application of zero PEEP (known as ZEEP) or 5 cm H 2 O PEEP in obese patients undergoing laparoscopic surgery. 98 The degree of obesity, intraoperative positioning, and the nature of the surgery (laparoscopic surgery vs open) will dictate the frequency of these maneuvers, but repeated application is more effective than a single post-induction recruitment. 99 There is no benefit to the use of high tidal volumes in an attempt to maintain FRC.…”

Airway management and oxygenation in obese patients

“…50 Obese patients receiving a vital capacity maneuver (VCM) 40 cm H 2 O for seven to eight seconds followed by PEEP 10 cm H 2 O were observed to have improved intraoperative and postoperative oxygenation, and their atelectasis scores were lower on chest computerized tomography at two hours postoperatively when compared with obese patients receiving VCM alone. 51 Almarakbi et al also observed superior respiratory compliance and PaO 2 in obese patients undergoing laparoscopic gastric banding with repeated inspiratory recruitment maneuvres (40 cm H 2 O for 15 sec repeated every ten minutes) followed by PEEP (10 cm H 2 O). 52 Obese patients may require high peak airway pressures with the application of PEEP 10 cm H 2 O after recruitment maneuvers.…”