Perioperative medicine (London, England) · 2026
Individualized PEEP titration guided by static lung compliance reduces postoperative atelectasis in elderly patients during laparoscopic Trendelenburg surgery: a randomized controlled trial.
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Li Jinze, Cao Xuepeng, Huang Liquan, Han Guojie, Wang Xiuqin
Аннотация
OBJECTIVE: To investigate the lung protective effects of individualized positive end-expiratory pressure (PEEP) titration guided by static lung compliance (Cstat) in elderly patients undergoing laparoscopic surgery in the Trendelenburg position.
METHODS: Seventy elderly patients aged 65-75 years scheduled for elective laparoscopic rectal cancer surgery with anticipated duration > 2 h were enrolled. Patients had ASA physical status II-III and BMI 19-28 kg/m2. Patients were equally divided into two groups: individualized PEEP guided by static lung compliance (CV group) and fixed PEEP group (DV group). Lung ultrasound scores (LUS) were performed after invasive arterial monitoring establishment (T1), immediately post-surgery (T4), before discharge from PACU (T5). Central venous blood samples were collected at T1 and T5 for ELISA determination of IL-6, CC16, and SP-A. Peak airway pressure, plateau pressure, alveolar dead space fraction (VD/VT), PaO2/FiO2 ratio, and invasive arterial pressure were recorded.
RESULTS: Compared with the DV group, the CV group demonstrated significantly lower lung ultrasound scores at T4 (mean difference: -4.0, 95% CI: -7.0 to -2.0) and T5 (mean difference: -4.06, 95% CI: -6.3 to -1.7), significantly higher SP-A (median difference: 33.39, 95% CI:15.90 to 47.44) at T5, and increased dynamic and static compliance with decreased driving pressure at T3 and T4 (all p < 0.05). No significant differences were observed in VD/VT, PaO₂/FiO₂ ratio, or invasive arterial pressure.
CONCLUSION: For elderly patients undergoing laparoscopic rectal cancer surgery in the Trendelenburg position, individualized PEEP titration based on static lung compliance is associated with lower postoperative lung ultrasound scores (primarily located in the lateral and posterior zones) and may potentially alleviate atelectasis. This strategy is associated with improved intraoperative lung compliance, decreased driving pressure, and increased postoperative serum SP-A concentration, potentially providing intraoperative lung protection. Future studies should evaluate hard clinical outcomes, such as postoperative pulmonary complications (PPCs), as primary endpoints.
TRIAL REGISTRATION: China Clinical Trial Registry, 7/26/2024, ChiCTR2400087409.
METHODS: Seventy elderly patients aged 65-75 years scheduled for elective laparoscopic rectal cancer surgery with anticipated duration > 2 h were enrolled. Patients had ASA physical status II-III and BMI 19-28 kg/m2. Patients were equally divided into two groups: individualized PEEP guided by static lung compliance (CV group) and fixed PEEP group (DV group). Lung ultrasound scores (LUS) were performed after invasive arterial monitoring establishment (T1), immediately post-surgery (T4), before discharge from PACU (T5). Central venous blood samples were collected at T1 and T5 for ELISA determination of IL-6, CC16, and SP-A. Peak airway pressure, plateau pressure, alveolar dead space fraction (VD/VT), PaO2/FiO2 ratio, and invasive arterial pressure were recorded.
RESULTS: Compared with the DV group, the CV group demonstrated significantly lower lung ultrasound scores at T4 (mean difference: -4.0, 95% CI: -7.0 to -2.0) and T5 (mean difference: -4.06, 95% CI: -6.3 to -1.7), significantly higher SP-A (median difference: 33.39, 95% CI:15.90 to 47.44) at T5, and increased dynamic and static compliance with decreased driving pressure at T3 and T4 (all p < 0.05). No significant differences were observed in VD/VT, PaO₂/FiO₂ ratio, or invasive arterial pressure.
CONCLUSION: For elderly patients undergoing laparoscopic rectal cancer surgery in the Trendelenburg position, individualized PEEP titration based on static lung compliance is associated with lower postoperative lung ultrasound scores (primarily located in the lateral and posterior zones) and may potentially alleviate atelectasis. This strategy is associated with improved intraoperative lung compliance, decreased driving pressure, and increased postoperative serum SP-A concentration, potentially providing intraoperative lung protection. Future studies should evaluate hard clinical outcomes, such as postoperative pulmonary complications (PPCs), as primary endpoints.
TRIAL REGISTRATION: China Clinical Trial Registry, 7/26/2024, ChiCTR2400087409.