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Poster

Patient Spirometry: Diagnosis and Treatment of Pneumothorax during Laparoscopy

A poster presentation documents the efficacy of PEEP treatment of a 22-year-old woman who received a laparoscopic fundoplication performed in the 10-degree head-up position with intra-abdominal pressure of 14 mmHg

Diagnosis and treatment of pneumothorax during laparoscopy

Case Report

22 year-old woman, 58 kg, 170 cm

Laparoscopic fundoplication performed in 10° head-up position. Intra-abdominal pressure 14 mmHg.

Case Evolution

I. Intra-abdominal CO₂ insufflation

  • Compliance decreases
  • Pplat increases
  • ETCO₂ increases

II. Pneumothorax occurs - diagnosis

  • Compliance decreases further
  • Pplat increases further
  • ETCO2 increases further
  • The occurrence of pneumothorax was confirmed through fluoroscopy

III. Treatment with PEEP - improvement

  • Compliance improves
  • Pplat decreases gradually
  • ETCO₂ decreases

IV. Deflation of the abdomen

Combined_PatientSpirometry
Combined Patient Spirometry and gas monitoring enables early diagnosis of pneumothorax by simultaneously monitoring ETCO₂, dynamic compliance and airway pressures.

Graphic evidence of efficacy of PEEP treatment

Efficacy of PEEP treatment
Figure 1
Efficacy of PEEP treatment
Figure 2
Efficacy of PEEP treatment
Figure 3

I = After CO₂ insufflation
II = After pneumothorax has developed
III = PEEP 6 cmH₂O – compliance improves
IV = PEEP 8 cmH₂O – compliance improves further

References

Joris JL, Chiche J-D, Lamy ML: Pneumothorax During Laparoscopic Fundoplication: Diagnosis and Treatment with Positive End-Expiratory Pressure, Anesth Analg; 81:993-1000, (1995).

  • Respiratory
  • Airway gases
  • Intensive care
  • Clinical