Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.

Published

Journal Article

OBJECTIVES: To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. METHODS: We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression. RESULTS: Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). CONCLUSIONS: In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.

Full Text

Duke Authors

Cited Authors

  • Ehieli, EI; Howard, LE; Monk, TG; Ferrandino, MN; Polascik, TJ; Walther, PJ; Freedland, SJ

Published Date

  • August 2016

Published In

Volume / Issue

  • 23 / 8

Start / End Page

  • 674 - 678

PubMed ID

  • 27225958

Pubmed Central ID

  • 27225958

Electronic International Standard Serial Number (EISSN)

  • 1442-2042

Digital Object Identifier (DOI)

  • 10.1111/iju.13125

Language

  • eng

Conference Location

  • Australia