Optimizing Ventilation Strategies to Reduce Pulmonary Complications in Frail Patients: A Comparative Study

BACKGROUND Frailty is a clinical syndrome with reduced physiological reserve and diminished resilience to surgical stress, predisposing patients to postoperative pulmonary complications (PPCs). This prospective observational study included 61 frail patients undergoing non-cardiac surgery (NCS) and aimed to compare postoperative pulmonary outcomes between standard positive end-expiratory pressure (PEEP) ventilation and driving pressure-guided individualized ventilation. MATERIAL AND METHODS Patients were assigned to either a driving pressure-guided ventilation group (DP group, n=31) or a standard PEEP ventilation group (N group, n=30). The ΔP group received individualized PEEP titrated to minimize driving pressure (plateau pressure minus PEEP), while the N group received a fixed PEEP of 5 cmH₂O. The primary outcome was the incidence of PPCs within 7 days. Secondary outcomes included plateau pressure (Pplat), airway pressure (Paw), dynamic lung compliance (Cdyn), arterial oxygen pressure (PaO₂), and oxygenation index (OI), measured at 4 time points (T0: post-intubation; T1: 60 min after PEEP titration; T2: end of surgery; T3: 24 h postoperatively). RESULTS No PPCs occurred in the ΔP group, whereas 7 patients (23.3%) in the N group developed PPCs (P<0.01). The ΔP group also showed significantly lower Pplat and Paw and improved Cdyn at T0 (P<0.001), with no significant differences in PaO₂ or OI throughout the study period (P>0.05). CONCLUSIONS Driving pressure-guided individualized ventilation significantly reduced PPCs and improved perioperative respiratory parameters in frail patients undergoing NCS. This strategy may help optimize intraoperative ventilation in similar high-risk surgical patients.