Background: Positive end expiratory pressure (PEEP) at the time of induction increases oxygenation by preventing lung atelectasis. However, PEEP may not prove beneficial in all cases. Factors affecting the action of PEEP have not been elucidated well and remain controversial. Pulmonary vasculature has direct bearing on the action of PEEP as has been proven in previous studies. Thus this study was planned to evaluate the action of PEEP on the basis of pulmonary artery systolic pressure (PASP) which is non invasive and easily measured by trans-thoracic echocardiography. Methodology: This Randomized prospective study comprised of 70 morbidly obese patients, ASA grade II or III, aged 20-65 years with BMI \> 40kg/m2, scheduled for elective laparoscopic bariatric surgery. Ten patients had to be excluded. Thus a total of 60 patients participated in the study. Thirty patients received no PEEP at the time of induction while other 30 patients were given a PEEP of 10cm of H2O. Serial ABG samples were taken pre operatively, at the time of intubation, 5 min after intubation and 10 min after intubation. Patients were then divided into four groups on the basis of PASP value of ≤ 30 mm Hg with and without PEEP or \> 30 mm Hg
This prospective study was conducted in the Department Of Anaesthesiology\& Critical Care, Sri Aurobindo Institute of Medical Sciences \& P.G. Institute and Mohak Hospitals, Indore, over a period of one year. Seventy morbidly obese patients, ASA grade II or III, aged 20-65 years with BMI \> 40kg/m2, scheduled for elective laparoscopic bariatric surgery were selected and a written informed consent was obtained. All the recruited patients underwent 2D-trans-thoracic echocardiography and PASP was recorded. Echocardiography was performed by same cardiologist as this measurement is operator dependent. Patients who denied consent, those undergoing Emergency and/or open surgery and those requiring more than 2 attempts for intubation were excluded. Arterial line was inserted pre operatively and ABG sample was taken and hemodynamic parameter recording done while the patient was breathing room air. Both groups were pre-oxygenated for 3 minutes with 100% Oxygen. Standard procedure was used for induction of anesthesia in all the patients. No premedication was given. All the patients were induced with i.v. Glycopyrolate (0.005-0.01 mg/kg), i.v. Fentanyl (2µg/kg) and i.v. Propofol. Once the patient became unresponsive to verbal commands, Succinylcholine was then administered in a dose of 1- 1.5 mg/ kg. Mechanical ventilation was started with 100% oxygen. A PEEP of 10 cm H2O was applied using four hand technique in Study group while the control group received no PEEP. After one minute endotracheal intubation was done. PEEP was continued in study group after intubation. Arterial blood gas (ABG) analysis and hemodynamic parameters were recorded at following stages: 1. Just after inflation of cuff of endotracheal tube 2. 5 minutes post intubation 3. 10 minutes post intubation Patients were then again divided into four groups on the basis of PASP: Group 1: Patients with PASP ≤ 30 mmHg receiving no PEEP (n= 11) Group 2: PASP ≤ 30 mm Hg receiving PEEP of 10 cm H2O (n= 11) Group 3: PASP \> 30 mm Hg receiving no PEEP (n= 19) Group 4: PASP \> 30 mm Hg receiving PEEP of 10 cm H2O (n=19)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
SINGLE
Enrollment
70
Positive end expiratory pressure was applied using anesthesia machine at the time of induction in the patients undergoing laparoscopic bariatric surgery
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial oxygenation (PaO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP preoperatively just before taking the patient in operation theater
Time frame: Arterial oxygenation (PaO2) in mm Hg recorded preoperatively and taken as baseline value
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction of general anesthesia
Arterial carbon di oxide (PaCO2) values in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP preoperatively just before taking the patient in operation theater
Time frame: Arterial carbon di oxide (PaCO2) in mm Hg was recorded from ABG preoperatively and taken as baseline value
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction of general anesthesia
Pulse Rate (beats/ min) was recorded and compared between group receiving PEEP and group not receiving PEEP preoperatively just before taking the patient in operation theater
Time frame: Pulse Rate (beats/ min) was recorded from ABG preoperatively and taken as baseline value
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction of general anesthesia
Systolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP preoperatively just before taking the patient in operation theater
Time frame: Systolic BP in mm Hg was recorded from ABG preoperatively and taken as baseline value
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction of general anesthesia
Diastolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP preoperatively just before taking the patient in operation theater
Time frame: Diastolic BP in mm Hg was recorded from ABG preoperatively and taken as baseline value
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial oxygenation (PaO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP just after the placement and cuff inflation of endotracheal tube
Time frame: Arterial oxygenation (PaO2) in mm Hg was recorded just after the placement and cuff inflation of endotracheal tube
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial carbon di oxide (PaCO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP just after the placement and cuff inflation of endotracheal tube
Time frame: Arterial carbon di oxide (PaCO2) in mm Hg was recorded just after the placement and cuff inflation of endotracheal tube
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Pulse rate (beats/ min) was recorded and compared between group receiving PEEP and group not receiving PEEP just after the placement and cuff inflation of endotracheal tube
Time frame: Pulse rate (beats/ min) was recorded just after the placement and cuff inflation of endotracheal tube
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Systolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP just after the placement and cuff inflation of endotracheal tube
Time frame: Systolic BP in mm Hg was recorded just after the placement and cuff inflation of endotracheal tube
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Diastolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP just after the placement and cuff inflation of endotracheal tube
Time frame: Diastolic BP in mm Hg was recorded just after the placement and cuff inflation of endotracheal tube
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial oxygenation (PaO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP five minutes after intubation
Time frame: Arterial oxygenation (PaO2) in mm Hg was recorded five minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial carbon di oxide (PaCO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP five minutes after intubation
Time frame: Arterial carbon di oxide (PaCO2) in mm Hg was recorded five minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Pulse rate (beats/ min) was recorded and compared between group receiving PEEP and group not receiving PEEP five minutes after intubation
Time frame: Pulse rate (beats/ min) was recorded five minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Systolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP five minutes after intubation
Time frame: Systolic BP in mm Hg was recorded five minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Diastolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP five minutes after intubation
Time frame: Diastolic BP in mm Hg was recorded five minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial oxygenation (PaO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP ten minutes after intubation
Time frame: Arterial oxygenation (PaO2) in mm Hg was recorded ten minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Arterial carbon di oxide (PaCO2) in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP ten minutes after intubation
Time frame: Arterial carbon di oxide (PaCO2) in mm Hg was recorded ten minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Pulse rate (beats/ min) was recorded and compared between group receiving PEEP and group not receiving PEEP ten minutes after intubation
Time frame: pulse Rate (beats/ min) was recorded ten minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Systolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP ten minutes after intubation
Time frame: Systolic BP in mm Hg was recorded ten minutes post intubation
effect of PEEP of 10 cm H2O on arterial blood gases and hemodynamic parameters, when applied at the time of induction
Diastolic BP in mm Hg was recorded and compared between group receiving PEEP and group not receiving PEEP ten minutes after intubation
Time frame: Diastolic BP in mm Hg was recorded ten minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Preoperative arterial oxygenation was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded preoperatively and taken as baseline value
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Preoperative arterial carbon di oxide was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded preoperatively and taken as baseline value
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Preoperative pulse rate was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded preoperatively and taken as baseline value
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Systolic blood pressure was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded preoperatively and taken as baseline value
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
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Diastolic blood pressure was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded preoperatively and taken as baseline value
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial oxygenation recorded just after the placement and cuff inflation of endotracheal tube, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded just after the placement and cuff inflation of endotracheal tube
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial carbon di oxide (mm Hg) recorded just after the placement and cuff inflation of endotracheal tube, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded just after the placement and cuff inflation of endotracheal tube
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Pulse rate (beats/ min) recorded just after the placement and cuff inflation of endotracheal tube, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameters was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded just after the placement and cuff inflation of endotracheal tube
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Systolic pressure(mm Hg) recorded just after the placement and cuff inflation of endotracheal tube, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded just after the placement and cuff inflation of endotracheal tube
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Diastolic blood pressure(mm Hg) recorded just after the placement and cuff inflation of endotracheal tube, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded just after the placement and cuff inflation of endotracheal tube
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial oxygenation recorded five minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded five minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial carbon di oxide (mm Hg) recorded five minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded five minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Pulse rate (beats/ min) recorded five minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded five minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Systolic pressure(mm Hg) recorded five minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded five minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Diastolic blood pressure(mm Hg) recorded five minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded five minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial oxygenation (mm Hg) recorded ten minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded ten minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Arterial carbon di oxide (mm Hg) recorded ten minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded ten minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Pulse rate (beats/ min) recorded ten minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded ten minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Systolic blood pressure (mm Hg) recorded ten minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded ten minutes post intubation
Effect of pulmonary artery systolic pressure (PASP) on the efficacy of PEEP as reflected by changes in ABG and hemodynamic parameters
Diastolic blood pressure(mm Hg) recorded ten minutes after intubation, was compared of those patients who received PEEP and had PASP ≤ 30 mm Hg with those patients who did not receive PEEP and had PASP ≤ 30 mm Hg. Similarly the above parameter was compared in patients with PASP \> 30 mm Hg receiving PEEP with those not receiving any PEEP
Time frame: ABG and hemodynamic parameters were recorded ten minutes post intubation