During pneumoperitoneum, intra-abdominal pressure (IAP) is usually kept at 12-14 mmHg. There is no clinical benefit in IAP increments if they do not increase intra-abdominal volume IAV. We aimed to estimate IAV (ΔIAV) and respiratory driving pressure changes (ΔP_RS) in relation to changes in IAP (ΔIAP). We carried out a patient-level meta-analysis of 204 adult patients with available data on IAV and ΔP_RS during pneumoperitoneum from three trials assessing the effect of IAP on postoperative recovery and airway pressure during laparoscopic surgery under general anesthesia. The primary endpoint was ΔIAV, and the secondary endpoint was ΔP_RS. The endpoints' response to ΔIAP was modeled using mixed multivariable Bayesian regression to estimate which mathematical function best fitted it. IAP values on the pressure-volume (PV) curve where the endpoint rate of change according to IAP decreased were identified. Abdomino-thoracic transmission (ATT) rate, i.e., the rate ΔP_RS changeto ΔIAP, was also estimated. The best-fitting function was sigmoid logistic and linear for IAV and ΔP_RS response, respectively. Increments in IAV reached a plateau at 6.0 [95%CI 5.9 to 6.2] L. ΔIAV for each ΔIAP decreased at IAP ranging from 9.8 [95%CI 9.7 to 9.9], to 12.2 [12.0 to12.3] mmHg. ATT rate was 0.65 [95%CI 0.62 to 0.68]. One mmHg of IAP raised ΔP_RS 0.88 cmH₂O. During pneumoperitoneum, IAP has a non-linear relationship with IAV and a linear one with ΔP_RS. IAP should be set below the point where IAV gains diminish.

中文翻译：

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在气腹通气过程中模拟腹腔容积和呼吸驱动压力-患者水平的数据荟萃分析

气腹期间，腹腔内压力（IAP）通常保持在12-14 mmHg。如果IAP增加不增加腹腔内IAV，则无临床益处。我们的目的是评估IAV（ΔIAV）和呼吸驱动压力变化（ΔP _RS相对于在IAP）的变化（ΔIAP）。我们进行了204例成人对IAV和ΔP可用数据的患者水平荟萃分析_RS气腹期间从三个试验评估IAP对术后恢复的影响，并在全身麻醉下腹腔镜手术时气道压力。主要终点是ΔIAV，和次级终点是ΔP _RS。使用混合的多变量贝叶斯回归模型对端点对ΔIAP的响应进行建模，以估计哪个数学函数最适合它。确定了压力-体积（PV）曲线上的IAP值，其中根据IAP的端点变化率降低了。腹胸传输（ATT）速率，即，速率ΔP _RS变化还估计了ΔIAP。最佳拟合函数是为IAV和ΔP乙状结肠后勤和线性_RS响应，分别。IAV的增量在6.0 [95％CI 5.9至6.2] L处达到平稳。IAP中每个ΔIAP的ΔIAV范围从9.8 [95％CI 9.7至9.9]降低到12.2 [12.0-12.3] mmHg。ATT率为0.65 [95％CI 0.62至0.68]。IAP之一毫米汞柱升高ΔP _RS 0.88 CMH ₂ O.在气腹，IAP与IAV和非线性关系与ΔP线性一个_RS。应将IAP设置为低于IAV增益的水平。