EFFECT OF DIFFERENT LEVELS OF PEEP ON POSTOPERATIVE ATELECTASIS IN OBESE PATIENTS UNDERGOING LAPAROSCOPIC SURGERY

Abstract

Background: Obesity is one of the major causes of perioperative pulmonary complications especially atelectasis, which is caused by loss of lung compliance and functional residual capacity. Laparoscopy surgery also adds to these effects by pneumoperitoneum and diaphragm elevation. PEEP is important to prevent alveolar collapse and enhance oxygenation.

Objective: To compare the outcomes of normal PEEP and moderate PEEP on the occurrence of postoperative atelectasis among patients undergoing laparoscopic cholecystectomy in the case of obesity.

Methodology: The study design was the Cross sectional and the sample size was 100 obese patients subjected to laparoscopic cholecystectomy, and randomly divided into two groups according to ventilation strategy normal PEEP (5 cmH2o) and moderate PEEP (8-10 cmH2o). Preoperative, intraoperative and postoperative data were noted. Independent t-test and chi-square test were used to perform statistical analysis to compare the outcomes of groups.

Results: One patient (2% in normal PEEP group and none in moderate PEPS group) had postoperative atelectasis (p=0.315). The mean postoperative oxygen saturation was much better in the moderate PEEP group (98.88±0.38%), as compared to the normal PEEP group (98.14±0.80%) (p<0.001). The moderate PEEP group also had less postoperative complications (p=0.046). There were no notable differences in terms of age, BMI, duration of surgery and peak airway pressure between the groups (p>0.05).

Conclusion: Moderate PEEP is linked to better postoperative oxygen saturation and less pulmonary complications in obese patients with laparoscopic cholecystectomy. The decrease in atelectasis was not statistically significant, but the fact that there were no cases in the moderate PEEP group, indicates the possibility of a protective effect. It is arguable that moderate PEEP is a more effective ventilatory strategy in this population.