Repercussions of pneumoperitoneum for laparoscopic cholecystectomy on mechanical power with volume-controlled ventilation

<div> <p><strong><span lang="EN-GB"> </span></strong></p> <p><strong><span lang="EN-GB">Background </span></strong></p> <p><span lang="EN-GB">The installation of pneumoperitoneum alters mechanical ventilation mechanics, which can lead to an increase in mechanical power and lead to Ventilator-Induced Lung Injury (VILI) and postoperative pulmonary complications and reintubation. Aim: To analyse the repercussions of pneumoperitoneum on mechanical power during general anaesthesia for cholecystectomy, verify changes in the parameters of the components of ventilatory mechanics and their repercussions on mechanical power before, during and after pneumoperitoneum emptying. </span></p> <p><strong><span lang="EN-GB">Methods</span></strong></p> <p><span lang="EN-GB">Analytical, cross-sectional and observational study carried out between 2022 and 2023, in Sixty patients undergoing general anaesthesia for video laparoscopic cholecystectomy. The parameters of the components of the ventilatory mechanics were collected, such as RR, VT, Ppeak, Plateau, PEEP, ΔP, resistance and compliance, and the mechanical power during the intraoperative period, ten minutes before the pneumoperitoneum was performed, during the pneumoperitoneum and ten minutes after the pneumoperitoneum. When the hypothesis of equality of means in the three evaluation moments was rejected, these moments were compared two by two considering the LSD test. P < 0.05 indicated statistical significance. </span><strong><span lang="EN-GB">Results</span></strong></p> <p><span lang="EN-GB">The variables RR, Pplateau, ∆P, and compliance showed significant differences in three-by-three comparisons (P < 0.001) but not PEEP (P = 0.217) and VT (P = 0.338). The parameters Ppeak, resistance and mechanical power, in addition to presenting significant differences in the three-by-three comparisons (P < 0.001) also presented significant differences in the two-by-two comparison before and during, before and after, during and after the pneumoperitoneum. </span></p> <p><strong><span lang="EN-GB">Conclusion</span></strong></p> <p><span lang="EN-GB">Pneumoperitoneum during cholecystectomy surgery resulted in an increase in mechanical power above values considered protective during volume-controlled ventilation, due to reduced compliance and increased resistance, which tend to normalize after emptying. </span></p> <p><span lang="EN-GB"><span>                                                                                </span></span></p> <p><strong><span lang="EN-GB">Keywords</span></strong><span lang="EN-GB">: mechanical ventilation; mechanical power; video laparoscopy; pneumoperitoneum</span></p> </div>