The effect of positive end-expiratory pressure on inflammatory cytokines during laparoscopic cholecystectomy

Objectives: To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H 2 O on the plasma levels of cytokines during laparoscopic cholecystectomy.  Methods: A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Ozal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H 2 O PEEP) (n=20), and PEEP (10 cm H 2 O PEEP) (n=20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)- α , IL 10, and transforming growth factor (TGF)- β 1 were measured in the pre- and post-operatively collected samples.  Results: Blood samples of 30 patients’ were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients ( p =0.035). Post-operative plasma TGF- β 1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels ( p =0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups.  Conclusion: The application of PEEP of 10 cm H 2 O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery. Saudi Med J 2015; Vol. 36 (11): 1358-1362 doi: 10.15537/smj.2015.11.12442