Objective: To investigate the effects of pneumoperitoneum alone or combined with an alveolar recruitment maneuver (ARM) followed by positive end-expiratory pressure (PEEP) on cardiopulmonary function in sheep.
Study Design: Prospective, randomized, crossover study.
Animals: A total of nine adult sheep (36-52 kg).
Methods: Sheep were administered three treatments (≥10-day intervals) during isoflurane-fentanyl anesthesia and volume-controlled ventilation (tidal volume: 12 mL kg) with oxygen: CONTROL (no intervention); PNEUMO (120 minutes of CO pneumoperitoneum); PNEUMO (PNEUMO protocol with an ARM instituted after 60 minutes of pneumoperitoneum). The ARM (5 cmHO increases in PEEP of 1 minute duration until 20 cmHO of PEEP) was followed by 10 cmHO of PEEP until the end of anesthesia. Cardiopulmonary data were recorded until 30 minutes after abdominal deflation.
Results: PaO was decreased from 435-462 mmHg (58.0-61.6 kPa) (range of mean values in CONTROL) to 377-397 mmHg (50.3-52.9 kPa) in PNEUMO (p < 0.05). Quasistatic compliance (C, mL cmHO kg) was decreased from 0.85-0.92 in CONTROL to 0.52-0.58 in PNEUMO. PaO increased from 383-385 mmHg (51.1-51.3 kPa) in PNEUMO to 429-444 mmHg (57.2-59.2 kPa) in PNEUMO (p < 0.05) and C increased from 0.52-0.53 in PNEUMO to 0.70-0.74 in PNEUMO. Abdominal deflation in PNEUMO did not restore PaO and C to control values. Cardiac index (L minute m) decreased from 4.80-4.70 in CONTROL to 3.45-3.74 in PNEUMO and 3.63-3.76 in PNEUMO. Compared with controls, ARM/PEEP with pneumoperitoneum decreased mean arterial pressure from 81 to 68 mmHg and increased mean pulmonary artery pressure from 10 to 16 mmHg.
Conclusions And Clinical Relevance: Abdominal deflation did not reverse the pulmonary function impairment associated with pneumoperitoneum. The ARM/PEEP improved respiratory compliance and reversed the oxygenation impairment induced by pneumoperitoneum with acceptable hemodynamic changes in healthy sheep.
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