The Effects of Alveolar Recruitment Maneuver Versus Low Tidal Volume Ventilation on Oxygenation and Lung Mechanics in Patients Undergoing Laparoscopic Surgeries: A Prospective Randomized Controlled Study

Different ventilatory strategies have been studied to improve gas exchange and compliance of the lungs in patients undergoing laparoscopic surgeries. This study aimed to test the impact of alveolar recruitment maneuver versus low tidal volume ventilation combine with PEEP on arterial oxygenation and lung mechanics in patients undergoing laparoscopic surgeries. Sixty patients were randomly allocated into three equal groups according to the type of ventilation strategy used during surgery. In the control group, patients received conventional volume-controlled ventilation with 10ml/Kg VT and zero PEEP (ZEEP). In group II ( LTV ), patients received low tidal volume ventilation in the form of 6-8 ml/Kg VT and PEEP 5cmH2O. In group III (REC), patients received 6-8 ml/Kg and recruitment maneuvers were done every 10 minutes after intubation till extubation by manual inflation to 40cmH2O peak inspiratory pressure for 15 seconds then the patient was placed back to the same ventilation settings with PEEP of 5cmH2O. The primary outcome is the dynamic compliance. The secondary outcome measures include PaO2, PH, PCO2, SPO2, HR and MAP. Demographic characteristics and duration of surgery were comparable among groups. PaO2 was highly significantly increased (p <0.001) in the recruitment group (Rec) compared to the conventional group (C) and low tidal volume ventilation group (LTV). There was significant increase in dynamic compliance in the recruitment group (REC) compared with the conventional (C) and low tidal volume (LTV) groups. SpO2, PaCO2 showed a highly statistical significance differences between the three ventilated groups. There were no statistically significant differences between the three ventilated groups in terms of PH. There were no statistically significant differences between the three ventilated groups in terms of Mean arterial blood pressure and HR. repeated recruitment maneuvers combined with 5 cm H2O of PEEP increased respiratory system compliance and PaO2 in patients undergoing laparoscopic surgeries without hemodynamics adverse effects.