Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery
Por:
Díaz-Cambronero O, Mazzinari G, Flor Lorente B, García Gregorio N, Robles-Hernandez D, Olmedilla Arnal LE, Martin de Pablos A, Schultz MJ, Errando CL, Argente Navarro MP and on behalf of the IPPColLapSe II study investigators
Publicada:
1 nov 2020
Ahead of Print:
1 jun 2020
Categoría:
Surgery
Resumen:
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 center dot 77, 95 per cent c.i. 1 center dot 19 to 6 center dot 40, P = 0 center dot 017; risk ratio (RR) 1 center dot 82, 1 center dot 79 to 1 center dot 87, P = 0 center dot 049). The IPP strategy was also associated with a higher probability of emotional (P = 0 center dot 013) and overall (P = 0 center dot 011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0 center dot 001) and the plasma neutrophil-lymphocyte ratio was lower (P = 0 center dot 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 ( ).
Filiaciones:
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
:
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
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