BJA open · 2026
Effect of intraoperative high positive end-expiratory pressure with recruitment manoeuvres versus low positive end-expiratory pressure on postoperative lung function in obese adults: a substudy of the protective ventilation in obese patients randomised controlled trial.
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Rousseleau Damien, Bluth Thomas, Bruneel Bas, Slabbaert Matti, Serpa Neto Ary, Schultz Marcus J, Gama de Abreu Marcelo, De Baerdemaeker Luc, PROBESE Investigators, Protective Ventilation Network, and the Clinical Trials Network of the European Society of Anaesthesiology and Intensive Care
Аннотация
BACKGROUND: Patients with obesity are at an increased risk of postoperative pulmonary complications and impaired lung function after general anaesthesia. Although higher levels of PEEP combined with recruitment manoeuvres may improve intraoperative respiratory mechanics, their effect on postoperative lung function remains uncertain. We evaluated whether high PEEP with recruitment manoeuvres improves postoperative spirometry in obese patients undergoing abdominal surgery.
METHODS: This single-centre substudy of the Protective Ventilation in Obese Patients randomised controlled trial was conducted at Ghent University Hospital, Belgium. Adults with a BMI of ≥35 kg·m-2 undergoing abdominal surgery were randomised to high PEEP (12 cm H2O) with recruitment manoeuvres or low PEEP (4 cm H2O) without routine recruitment manoeuvres. Both groups received low tidal volume ventilation (7 mL·kg-1 predicted body weight). The primary outcome was the change in forced expiratory volume in 1 s (FEV1) from baseline to postoperative day 1. Secondary outcomes included changes in spirometry variables and oxygen saturation.
RESULTS: Postoperative spirometry data were available for 44 patients (23 low PEEP, 21 high PEEP). Postoperative lung function declined in all patients. The change in FEV1 from baseline to postoperative day 1 did not differ between the low- and high-PEEP groups (-0.90 [0.68] L vs -0.93 [0.66] L; between-group effect 0.0 L; 95% confidence interval -0.4 to 0.4 L; P=0.89). No differences were observed in secondary outcomes.
CONCLUSIONS: In obese patients undergoing abdominal surgery with low tidal volume ventilation, high PEEP with recruitment manoeuvers did not improve postoperative spirometric outcomes or oxygen saturation compared with low PEEP without routine recruitment manoeuvres.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT02148692.
METHODS: This single-centre substudy of the Protective Ventilation in Obese Patients randomised controlled trial was conducted at Ghent University Hospital, Belgium. Adults with a BMI of ≥35 kg·m-2 undergoing abdominal surgery were randomised to high PEEP (12 cm H2O) with recruitment manoeuvres or low PEEP (4 cm H2O) without routine recruitment manoeuvres. Both groups received low tidal volume ventilation (7 mL·kg-1 predicted body weight). The primary outcome was the change in forced expiratory volume in 1 s (FEV1) from baseline to postoperative day 1. Secondary outcomes included changes in spirometry variables and oxygen saturation.
RESULTS: Postoperative spirometry data were available for 44 patients (23 low PEEP, 21 high PEEP). Postoperative lung function declined in all patients. The change in FEV1 from baseline to postoperative day 1 did not differ between the low- and high-PEEP groups (-0.90 [0.68] L vs -0.93 [0.66] L; between-group effect 0.0 L; 95% confidence interval -0.4 to 0.4 L; P=0.89). No differences were observed in secondary outcomes.
CONCLUSIONS: In obese patients undergoing abdominal surgery with low tidal volume ventilation, high PEEP with recruitment manoeuvers did not improve postoperative spirometric outcomes or oxygen saturation compared with low PEEP without routine recruitment manoeuvres.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT02148692.