Ultrasonographic Evaluation of the Impact of Positive End-Expiratory Pressure and Pulmonary Recruitment on Diaphragmatic Function in Laparoscopic Surgery Patients

Background Evidence suggests that gas insufflation during laparoscopic surgery may compromise diaphragmatic function potentially leading to postoperative respiratory challenges. The intraoperative use of positive end-expiratory pressure PEEP and pulmonary recruitment maneuvers could prevent atelectasis reducing respiratory complications. This study examined the effect of PEEP and recruitment maneuvers on diaphragmatic activity during laparoscopic procedures. Methods This randomized study involved patients undergoing laparoscopic abdominal surgery categorized into three groups via computer-generated selection Group A zero PEEP Group B PEEP at 5 cmH2O and Group C PEEP plus recruitment maneuvers. Measurements included diaphragmatic excursion peak inspiratory pressure hemodynamic parameters HR MAP and lung compliance. Results Average diaphragmatic excursion in cm was measured at several stages baseline pneumoperitoneum reverse Trendelenburg after extubation and at six hours postoperatively. In Group A values were recorded as 3.63plusmn0.28 3.04plusmn0.18 3.08plusmn0.008 2.88plusmn0.34 and 3.56plusmn0.33 respectively. Group B values were 3.65plusmn0.27 3.29plusmn0.30 3.13plusmn0.29 3.40plusmn0.37 and 3.65plusmn0.29 while Group C values were 3.75plusmn0.31 3.41plusmn0.28 3.20plusmn0.30 3.40plusmn0.34 and 3.74plusmn0.31. Notably Group A had significantly reduced compliance compared to Groups B and C while values in Group C were consistently higher despite no statistical difference between B and C. Conclusion The use of PEEP during laparoscopic surgeries supports diaphragmatic excursion. Furthermore recruitment maneuvers enhance diaphragmatic movement and dynamic compliance albeit with elevated peak inspiratory pressures compared to the other groups