Volume 83, Issue 6 (September 2025)
Tehran Univ Med J 2025, 83(6): 410-417 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Vatankhah Tarbebar M, Kashani S, Mohammadi M, Nik Eghbali Z, Malekshoar M. Effect of different levels of positive end-expiratory pressure on respiratory performance and hemodynamic parameters in patients undergoing laparoscopic cholecystectomy: a randomized double-blind clinical trial. Tehran Univ Med J 2025; 83 (6) :410-417
URL: http://tumj.tums.ac.ir/article-1-13668-en.html
URL: http://tumj.tums.ac.ir/article-1-13668-en.html
Majid Vatankhah Tarbebar1 
, Saeid Kashani1 , Milad Mohammadi1 , Zohreh Nik Eghbali1 , Mehrdad Malekshoar *2
, Saeid Kashani1 , Milad Mohammadi1 , Zohreh Nik Eghbali1 , Mehrdad Malekshoar *2
1- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. ,mdmalekshoar@gmail.com
2- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. ,
Abstract: (205 Views)
Background: Laparoscopic cholecystectomy is the gold standard for treating gallbladder diseases; however, it is associated with physiological challenges from pneumoperitoneum and specific patient positioning. Positive end-expiratory pressure (PEEP) may mitigate these effects, but the optimal level remains uncertain. This study compared the impact of three PEEP levels on respiratory performance and hemodynamic stability during laparoscopic cholecystectomy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
Keywords: hemodynamics, laparoscopic cholecystectomy, oxygenation, positive end-expiratory pressure (PEEP).
Type of Study: Original Article |
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
