Impacts of different ventilation modes on respiratory mechanics, blood gas and hemodynamics in elderly patients with laparoscopic cholecystectomy

In this study, the impacts of different ventilation modes on respiratory mechanics, blood gas and hemodynamics in elderly patients undergoing laparoscopic cholecystectomy (LC) were compared. 60 LC patients were divided into 3 groups: group L (low tidal volume), group L + P (low tidal volume + positive end expiratory pressure) and group C (large tidal volume). Endotracheal intubation was placed immediately after mechanical ventilation. Results showed that the pressure Ppeak and Pplat of the three groups increased after pneumoperitoneum, which increased the most significantly in group C (P<0.05). Ppeak and Pplat further raised with the extension of pneumoperitoneum time in group C (P<0.05). However, alveolar dynamic compliance (Cd) decreased the most significantly in group L + P (P<0.05). PETCO2 (partial pressure of end-tidal carbon dioxide) increased the most obviously in group L (P<0.05), and it further raised with the extension of pneumoperitoneum time (P<0.05). The pH value was lower after pneumoperitoneumin in group L (P<0.05), and it further decreased with the extension of pneumoperitoneum time (P<0.05). There was significant difference in pH value (P<0.05) and PaCO2 (partial pressure of atrial carbon dioxide) (P<0.05) at the end of surgery compared with that before pneumoperitoneum in group L. It is indicated that the combination of low tidal volume (VT) and low-level PEEP (Positive End Expiratory Pressure) will effectively reduce airway pressure, prevented lung injury and improve the effect of ventilation. Therefore, the combination mode of low tidal volume plus low-level PEEP was considered a safe and effective ventilation method towards elderly patients in laparoscopic surgery.