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We read with great interest the recently published article by Davarcı et al. [1] in your journal aimed at studying the effects of CO2-pneumoperitoneum at 12 mm Hg intraperitoneal pressure on end-tidal CO2 ( P E T CO2) concentration, arterial blood gas values and oxidative stress markers in blood, and bronchial lavage during laparoscopic cholecystectomy using a long protective strategy since our clinical [2] and experimental [3] results were in line with findings of this study [1]. The authors clearly demonstrated significant changes of the peak in respiratory pressure, dynamic lung compliance, P E T CO2, arterial pO2, pCO2, and pH values at the 30th min of CO2-pneumoperitoneum in comparison with parameters of both at the baseline and at the end of surgery. These changes we considered as consequences of a causative force of CO2-insufflation with increased content of CO2 in the body (rise of P E T CO2 and arterial pCO2), with subsequent mild respiratory or severe acidosis (reduced pH) depending on intraperitoneal pressure rate and CO2-pneumoperitoneum duration [4–6]. Subsequently, the dynamic lung compliance was reduced with increased peak of respiratory pressure in adult patients with ASA I/II [1].

Comment on “Evidence for Negative Effects of Elevated Intra-Abdominal Pressure on Pulmonary Mechanics and Oxidative Stress”