Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery.

Autor: Díaz-Cambronero O; Research Group in Perioperative Medicine, Castellón, Spain.; Department of Anaesthesiology, Castellón, Spain.; Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, PT17/0017/0035, Hospital Universitario y Politécnico la Fe, Castellón, Spain., Mazzinari G; Research Group in Perioperative Medicine, Castellón, Spain.; Department of Anaesthesiology, Castellón, Spain., Flor Lorente B; Department of Colorectal Surgery, Castellón, Spain., García Gregorio N; Research Group in Perioperative Medicine, Castellón, Spain.; Department of Anaesthesiology, Castellón, Spain., Robles-Hernandez D; Hospital General Universitario de Castellón, Castellón, Spain., Olmedilla Arnal LE; Hospital General Universitario Gregorio Marañón, Madrid, Spain., Martin de Pablos A; Hospital Universitario Virgen Macarena, Seville, Spain., Schultz MJ; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands.; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.; Nuffield Department of Medicine, University of Oxford, Oxford, UK., Errando CL; Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, and Departments of Anaesthesiology, Castellón, Spain., Argente Navarro MP; Research Group in Perioperative Medicine, Castellón, Spain.; Department of Anaesthesiology, Castellón, Spain.
Jazyk: angličtina
Zdroj: The British journal of surgery [Br J Surg] 2020 Nov; Vol. 107 (12), pp. 1605-1614. Date of Electronic Publication: 2020 Jun 07.
DOI: 10.1002/bjs.11736
Abstrakt: Background: It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery.
Methods: This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3.
Results: Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2·77, 95 per cent c.i. 1·19 to 6·40, P = 0·017; risk ratio (RR) 1·82, 1·79 to 1·87, P = 0·049). The IPP strategy was also associated with a higher probability of emotional (P = 0·013) and overall (P = 0·011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0·001) and the plasma neutrophil-lymphocyte ratio was lower (P = 0·029). Other endpoints were not affected.
Conclusion: In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 ( http://www.clinicaltrials.gov).
(© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: