Individualized PEEP ventilation between tumor resection and dural suture in craniotomy

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Neurosurgery

Background:

• Atelectasis commonly occurs after craniotomy under general anesthesia, impacting oxygenation.
• Standard protective ventilation strategies may increase intracranial pressure in craniotomy patients.
• Individualized positive end-expiratory pressure (PEEP) is explored as a safer alternative.

Purpose of the Study:

• To evaluate the efficacy of individualized PEEP ventilation during craniotomy.
• To determine if this strategy reduces postoperative atelectasis.
• To assess its impact on oxygenation and regional cerebral oxygen saturation (rScO2).

Main Methods:

• 96 patients undergoing tumor craniotomy were randomized into control (no PEEP) and individualized PEEP groups.
• Tidal volume and PEEP levels were adjusted based on surgical phase (tumor resection vs. dural suture).
• Measurements included PaO2/FiO2 ratio, lung ultrasound score (LUS), and rScO2.

Main Results:

• The individualized PEEP group showed significantly higher PaO2/FiO2 ratios (395 ± 62 vs. 344 ± 40) and rScO2 (67 ± 5 vs. 61 ± 4) compared to the control group.
• Lung ultrasound scores (LUS) were significantly lower in the individualized PEEP group (7.5 [5.3-8.3] vs. 10.0 [9.0-12.0]) 1 hour post-extubation.
• Individualized PEEP levels in the P group were 7.0 (4.0-9.0).

Conclusions:

• Individualized PEEP ventilation during specific phases of craniotomy effectively reduces postoperative atelectasis.
• This method improves oxygenation (PaO2/FiO2 ratio) and maintains regional cerebral oxygen saturation (rScO2).
• The findings support individualized PEEP as a beneficial ventilation strategy in craniotomy patients.