Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 4;15(11):1428.
doi: 10.3390/diagnostics15111428.

The Impact of Alveolar Recruitment Strategies on Perioperative Outcomes in Obese Patients Undergoing Major Gynecologic Cancer Surgeries: A Prospective Randomized Controlled Trial

Duygu Akyol  1 , Funda Gümüş Özcan  1
Affiliations

The Impact of Alveolar Recruitment Strategies on Perioperative Outcomes in Obese Patients Undergoing Major Gynecologic Cancer Surgeries: A Prospective Randomized Controlled Trial

Duygu Akyol et al. Diagnostics (Basel). .

Abstract

Background/Objectives: Lung-protective ventilation (LPV) reduces postoperative pulmonary complications (PPCs) in obese patients. While the roles of low tidal volume and positive end-expiratory pressure (PEEP) in LPV have been established in patients with healthy lungs, the protective effect of alveolar recruitment strategies (ARSs) remains a subject of debate. This study aims to evaluate the benefit of ARSs in patients with low-to-moderate risk according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score undergoing gynecologic cancer surgery with LPV and low tidal volume intraoperatively. Methods: A total of 88 obese patients were evaluated in this study. They were divided into two groups as the non-ARS group (non-ARS) and the ARS group (ARS). Intraoperative hemodynamics, blood gas analyses, respiratory mechanics, mechanical ventilator parameters, and postoperative outcomes were compared in these obese patients. Results: A total of 40 obese patients undergoing major gynecological cancer surgery were included in this study. Although the non-ARS group presented with higher weight (p < 0.05), body mass indexes were similar to the ARS group. Intraoperative blood gas analysis revealed higher end-tidal carbon dioxide (etCO2) levels in the non-ARS group during the T2 and T3 time intervals (p < 0.05). In the ARS group, peak inspiratory pressure (PIP) at T3 was lower, while drive pressures at T1 and T2 and dynamic compliance at T3 were higher (p < 0.05). Radiologic atelectasis scores were higher in the non-ARS group, indicating more atelectatic lung images (p < 0.05). PPC rates were similar across both groups. Conclusions: Although the ARS demonstrated positive effects on lung mechanics and radiologic atelectasis scores in major open gynecologic cancer surgeries, it did not effectively reduce postoperative pulmonary complications.

Keywords: alveolar recruitment strategy; lung-protective ventilation; obesity; postoperative pulmonary complications.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Consort flow diagram.
Figure 2
Figure 2
Study protocol of the groups.
Figure 3
Figure 3
Evaluation of blood gases between groups.
See this image and copyright information in PMC

References

    1. Salome C.M., King G.G., Berend N. Physiology of obesity and effects on lung function. J. Appl. Physiol. 2010;108:206–211. doi: 10.1152/japplphysiol.00694.2009. - DOI - PubMed
    1. Silva P.L., Ball L., Rocco P., Pelosi P. Physiological and pathophysiological consequences of mechanical ventilation. Semin. Respir. Crit. Care Med. 2022;43:321–334. doi: 10.1055/s-0042-1744447. - DOI - PubMed
    1. Fernandez-Bustamante A., Frendl G., Sprung J., Kor D.J., Subramaniam B., Martinez Ruiz R., Lee J.-W., Henderson W.G., Moss A., Mehdiratta N., et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: Amulticenter study by the perioperative research network investigators. JAMA Surg. 2017;152:157–166. doi: 10.1001/jamasurg.2016.4065. - DOI - PMC - PubMed
    1. Odor P.M., Bampoe S., Gilhooly D., Creagh-Brown B., Moonesinghe S.R. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ. 2020;368:m540. doi: 10.1136/bmj.m540. - DOI - PMC - PubMed
    1. Bigatello L., Pesenti A. Respiratory Physiology for the Anesthesiologist. Anesthesiology. 2019;130:1064–1077. doi: 10.1097/ALN.0000000000002666. - DOI - PubMed

LinkOut - more resources