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Individualized PEEP without Recruitment Maneuvers Improves Intraoperative Oxygenation: A Randomized Controlled Study.

Lili Pan1, Li Yang1, Lingling Gao1

  • 1Department of Anesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.

Bioengineering (Basel, Switzerland)
|October 28, 2023
PubMed
Summary

Electrical impedance tomography (EIT)-guided individualized positive end-expiratory pressure (PEEP) improved oxygenation and reduced hypoxemia in patients undergoing robot-assisted prostatectomy without recruitment maneuvers. This EIT-guided PEEP strategy offers a safe alternative for optimizing ventilation during surgery.

Keywords:
PaO2/FiO2electrical impedance tomographyoxygenationpositive end-expiratory pressurerobot-assisted laparoscopic prostatectomy

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Area of Science:

  • Anesthesiology
  • Respiratory Physiology
  • Medical Technology

Background:

  • Individualized positive end-expiratory pressure (PEEP) with recruitment maneuvers enhances intraoperative oxygenation in robot-assisted prostatectomy.
  • The efficacy of electrical impedance tomography (EIT)-guided individualized PEEP without recruitment maneuvers remains unestablished for improving intraoperative oxygenation.

Purpose of the Study:

  • To investigate whether EIT-guided individualized PEEP, without recruitment maneuvers, can improve intraoperative oxygenation in patients undergoing robot-assisted laparoscopic prostatectomy.

Main Methods:

  • Fifty-six male patients were randomized into two groups: individualized PEEP guided by EIT (Group PEEP_IND) and a fixed PEEP of 5 cm H2O (Group PEEP_5).
  • Group PEEP_IND received individualized PEEP guided by EIT, while Group PEEP_5 received a fixed PEEP of 5 cm H2O throughout the procedure.
  • The primary outcome was the ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2) before extubation.

Main Results:

  • The individualized PEEP group (median 16 cm H2O) demonstrated significantly higher PaO2/FiO2 ratios before extubation compared to the fixed PEEP group (71.6 ± 10.7 vs. 56.8 ± 14.1 kPa, p = 0.003).
  • Postoperative hypoxemia incidence was lower in the individualized PEEP group (3.8% vs. 26.9%, p = 0.021).
  • The individualized PEEP group also showed lower driving pressures (12.0 ± 3.0 vs. 15.0 ± 4.4 cm H2O, p = 0.044) and better respiratory system compliance (44.5 ± 12.8 vs. 33.6 ± 9.1 mL/cm H2O, p = 0.017).

Conclusions:

  • EIT-guided individualized PEEP without recruitment maneuvers effectively improves perioperative oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy.
  • This approach may offer a safer alternative to recruitment maneuvers, potentially mitigating intraoperative hemodynamic instability.
  • The findings suggest EIT-guided individualized PEEP is a valuable strategy for optimizing respiratory management in this patient population.