Tommaso Pozzi, Silvia Coppola, Giulia Catozzi, Andrea Colombo, Mara Chioccola, Eleonora Duscio, Fabiano Di Marco, Davide Chiumello
{"title":"机器人辅助腹腔镜前列腺切除术中的机械动力：一项观察研究。","authors":"Tommaso Pozzi, Silvia Coppola, Giulia Catozzi, Andrea Colombo, Mara Chioccola, Eleonora Duscio, Fabiano Di Marco, Davide Chiumello","doi":"10.1007/s10877-024-01170-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP.</p><p><strong>Methods: </strong>Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH<sub>2</sub>O was studied.</p><p><strong>Results: </strong>The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 - 15.5] vs 9.2 [7.5 - 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH<sub>2</sub>O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 - 10.4] vs 12.1 [11.4 - 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 - 14.3] vs 15.5 [15.0 - 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 - 10.7] vs 12.7 [12.0 - 13.6] J/min, p < 0.001), without affecting respiratory system elastance.</p><p><strong>Conclusion: </strong>Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427604/pdf/","citationCount":"0","resultStr":"{\"title\":\"Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study.\",\"authors\":\"Tommaso Pozzi, Silvia Coppola, Giulia Catozzi, Andrea Colombo, Mara Chioccola, Eleonora Duscio, Fabiano Di Marco, Davide Chiumello\",\"doi\":\"10.1007/s10877-024-01170-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP.</p><p><strong>Methods: </strong>Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH<sub>2</sub>O was studied.</p><p><strong>Results: </strong>The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 - 15.5] vs 9.2 [7.5 - 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH<sub>2</sub>O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 - 10.4] vs 12.1 [11.4 - 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 - 14.3] vs 15.5 [15.0 - 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 - 10.7] vs 12.7 [12.0 - 13.6] J/min, p < 0.001), without affecting respiratory system elastance.</p><p><strong>Conclusion: </strong>Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance.</p>\",\"PeriodicalId\":15513,\"journal\":{\"name\":\"Journal of Clinical Monitoring and Computing\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427604/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Monitoring and Computing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10877-024-01170-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Monitoring and Computing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10877-024-01170-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study.
Background: Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP.
Methods: Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH2O was studied.
Results: The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 - 15.5] vs 9.2 [7.5 - 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH2O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 - 10.4] vs 12.1 [11.4 - 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 - 14.3] vs 15.5 [15.0 - 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 - 10.7] vs 12.7 [12.0 - 13.6] J/min, p < 0.001), without affecting respiratory system elastance.
Conclusion: Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance.
期刊介绍：
The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine.
The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group.
The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.
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