Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Abstract

Background Driving pressure (ΔP = Plateau pressure-PEEP) is highly correlated with postoperative pulmonary complications (PPCs) and appears to be a promising indicator for optimizing ventilator settings. We hypothesized that dynamic, individualized positive end-expiratory pressure (PEEP) guided by ΔP could reduce postoperative atelectasis and improve intraoperative oxygenation, respiratory mechanics, and reduce the incidence of PPCs on elderly patients undergoing laparoscopic surgery. Methods Fifty-one elderly patients who were subject to laparoscopic surgery participated in this randomized trial. In the PEEP titration group (DV group), the PEEP titration was decremented to the lowest ΔP and repeated every 1 h. Additional procedures were also performed when performing predefined events that may be associated with lung collapse. In the constant PEEP group (PV group), a PEEP of 6 cmH2O was used throughout the surgery. Moreover, zero PEEP was applied during the entire procedure in the conventional ventilation group (CV group). The primary objective of this study was lung ultrasound score noted at the end of surgery and 15 min after admission to the post-anesthesia care unit (PACU) at 12 lung areas bilaterally. The secondary endpoints were perioperative oxygenation function, expiratory mechanics, and the incidence of the PPCs. Results The lung ultrasound scores of the DV group were significantly lower than those in the PV group and CV group (P < 0.05), whereas there was no significant difference between the PV group and CV group (P > 0.05). The lung static compliance (Cstat) and ΔP at all the intraoperative time points in the DV group were significantly better compared to the PV group and the CV group (p < 0.05). Conclusions Intraoperative titrated PEEP reduced postoperative lung atelectasis and improved respiratory mechanics in elderly patients undergoing laparoscopic surgery. Meanwhile, standard PEEP strategy is not superior to conventional ventilation in reducing postoperative pulmonary atelectasis in laparoscopic surgery.

Effect of individualized PEEP on lung ultrasound score and optic nerve sheath diameter in elderly patients undergoing laparoscopic radical resection of rectal cancer A Randomized,Single blind, Prospective Study

“…The LUS can be used to quantitatively evaluate changes in pulmonary ventilation during the perioperative period [16][17][18][19][20][21][22]. This study showed that setting individualized PEEP according to driving pressure can reduce the LUS 30 min after surgery, improves oxygenation before extubation, and has a lung-protection effect, which is consistent with the results of previous studies [23].…”

Driving Pressure-Guided Ventilation in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

“…In contrast, VT and PEEP are only associated with the development of PPCs if they result in a change in driving pressure. The results of several randomized controlled studies 12 , 22 , 23 have demonstrated that a driving pressure-guided ventilation strategy is superior to a conventional LPVS in reducing the incidence of PPCs. One study 24 showed a 3.4% increase in the incidence of major morbidity in patients for every 1 cm H 2 O increase in driving pressure.…”

“…The incidence of PPCs within three days after surgery was recorded (three or more new findings: cough, increased sputum, dyspnea, chest pain, temperature > 38 °C, and heart rate > 100 beats/min). 12 …”

Driving pressure-guided ventilation improves homogeneity in lung gas distribution for gynecological laparoscopy: a randomized controlled trial

“…A recent retrospective cohort analysis 24 Accordingly, recent prospective studies demonstrated that PEEP optimization guided by DP is associated with a lower incidence of PPCs in both thoracic and abdominal surgery 2,25 . For elderly patients undergoing laparoscopic surgery 26 , DP-guided individualized PEEP has reduced lung atelectasis at the end of surgery and 15 min after admission to PACU. The intraoperative respiratory mechanics have also been improved.…”