Individualized positive end-expiratory pressure in laparoscopic surgery: a randomized controlled trial

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Reduced functional residual capacity (FRC) is a key factor in postoperative pulmonary complications.
• Positive end-expiratory pressure (PEEP) is crucial for maintaining FRC during mechanical ventilation.
• Previous research suggests driving pressure-guided PEEP may reduce postoperative pulmonary complications.

Purpose of the Study:

• To test the hypothesis that individualized PEEP increases immediate postoperative FRC.
• To determine if individualized PEEP improves lung ventilation.
• To evaluate the impact of individualized PEEP on postoperative pulmonary complications and oxygenation.

Main Methods:

• A single-centered randomized controlled trial involving 91 patients undergoing laparoscopic colorectal surgery.
• Patients were assigned to either individualized PEEP guided by minimum driving pressure or a fixed PEEP of 6 cmH2O.
• Primary outcome was postoperative FRC; secondary outcomes included pulmonary complications, oxygenation index, and ventilation parameters.

Main Results:

• Individualized PEEP group showed significantly higher postoperative FRC (32.8 mL/kg) compared to the fixed PEEP group (25.0 mL/kg).
• Driving pressure-guided PEEP resulted in a higher Oxygenation Index and improved ventilation distribution.
• This approach led to lower alveolar-arterial oxygen tension difference (PA-aO2), intrapulmonary shunt (QS/QT), and Respiratory Index.

Conclusions:

• Driving pressure-guided PEEP effectively preserves postoperative FRC in patients undergoing laparoscopic colorectal surgery.
• Individualized PEEP optimizes lung ventilation and oxygenation in this patient population.
• This strategy may reduce the incidence of postoperative pulmonary complications.