Effect of PEEP on regional ventilation during laparoscopic surgery monitored by electrical impedance tomography

J. Karsten*, H. Luepschen, M. Grossherr, H. P. Bruch, S. Leonhardt, H. Gehring, Torsten Meier

*Corresponding author for this work
32 Citations (Scopus)


Background: Anesthesia per se and pneumoperitoneum during laparoscopic surgery lead to atelectasis and impairment of oxygenation. We hypothesized that a ventilation with positive end-expiratory pressure (PEEP) during general anesthesia and laparoscopic surgery leads to a more homogeneous ventilation distribution as determined by electrical impedance tomography (EIT). Furthermore, we supposed that PEEP ventilation in lung-healthy patients would improve the parameters of oxygenation and respiratory compliance. Methods: Thirty-two patients scheduled to undergo laparoscopic cholecystectomy were randomly assigned to be ventilated with ZEEP (0 cmH 2O) or with PEEP (10 cmH 2O) and a subsequent recruitment maneuver. Differences in regional ventilation were analyzed by the EIT-based center-of-ventilation index (COV), which quantifies the distribution of ventilation and indicates ventilation shifts. Results: Higher amount of ventilation was examined in the dorsal parts of the lungs in the PEEP group. Throughout the application of PEEP, a lower shift of ventilation was found, whereas after the induction of anesthesia, a remarkable ventral shift of ventilation in ZEEP-ventilated patients (COV: ZEEP, 40.6 ± 2.4%; PEEP, 46.5 ± 3.5%; P<0.001) was observed. Compared with the PEEP group, ZEEP caused a ventral misalignment of ventilation during pneumoperitoneum (COV: ZEEP, 41.6 ± 2.4%; PEEP, 44 ± 2.7%; P=0.013). Throughout the study, there were significant differences in the parameters of oxygenation and respiratory compliance with improved values in PEEP-ventilated patients. Conclusion: The effect of anesthesia, pneumoperitoneum, and different PEEP levels can be evaluated by EIT-based COV monitoring. An initial recruitment maneuver and a PEEP of 10 cmH 2O preserved homogeneous regional ventilation during laparoscopic surgery in most, but not all, patients and improved oxygenation and respiratory compliance.

Original languageEnglish
JournalActa Anaesthesiologica Scandinavica
Issue number7
Pages (from-to)878-886
Number of pages9
Publication statusPublished - 01.08.2011


Dive into the research topics of 'Effect of PEEP on regional ventilation during laparoscopic surgery monitored by electrical impedance tomography'. Together they form a unique fingerprint.

Cite this