Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials

Gulfairus A. Yessenbayeva, Aizhan Meyerbekova, Sergey I. Kim, Murat B. Zhumabayev, Gulbanu S. Berdiyarova, S. B. Shalekenov, Жарлыганова Динара Саркыбековна, Irina Y. Mukatova, Yekaterina A. Yukhnevich, Dmitriy Anatolyevich Klyuyev

1 more author

Andrey I. Yaroshetskiy

BMC Anesthesiology, 2025

Full text Open access: Gold Metadata (CSL-JSON)
DOI 10.1186/s12871-025-02933-2
Data confidence 85 high
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Abstract

High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics. We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0–5 mbar; moderate PEEP (MPEEP): 6–9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied. 8 RCTs ( n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO 2 /FiO 2 (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi 2 34.92, p < 0.0001; I 2 89%). iPEEP vs. LPEEP also increased PaO 2 /FiO 2 + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi 2 26.95, p < 0.0001; I 2 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi 2 93.16, p < 0.0001; I 2 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi 2 53.92, p < 0.0001; I 2 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons. In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive. CRD42023488971; registered December 14, 2023.