• Xiaojing Ma, Yunke Fu, Xiangmei Piao, Roberta Ribeiro De Santis Santiago, Libin Ma, Ying Guo, Qiang Fu, Weidong Mi, Lorenzo Berra, and Changsheng Zhang.
• From the Department of Anaesthesia, First Medical Centre (XM, YF, XP, LM, YG, QF, WM, CZ), National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, PR China and Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA (RRDSS, LB).
• Eur J Anaesthesiol. 2023 Nov 1; 40 (11): 805816805-816.

BackgroundA protective intra-operative lung ventilation strategy has been widely recommended for laparoscopic surgery. However, there is no consensus regarding the optimal level of positive end-expiratory pressure (PEEP) and its effects during pneumoperitoneum. Electrical impedance tomography (EIT) has recently been introduced as a bedside tool to monitor lung ventilation in real-time.ObjectiveWe hypothesised that individually titrated EIT-PEEP adjusted to the surgical intervention would improve respiratory mechanics during and after surgery.DesignRandomised controlled trial.SettingFirst Medical Centre of Chinese PLA General Hospital, Beijing.PatientsSeventy-five patients undergoing robotic-assisted laparoscopic hepatobiliary and pancreatic surgery under general anaesthesia.InterventionsPatients were randomly assigned 2 : 1 to individualised EIT-titrated PEEP (PEEPEIT; n = 50) or traditional PEEP 5 cmH2O (PEEP5 cmH2O; n = 25). The PEEPEIT group received individually titrated EIT-PEEP during pneumoperitoneum. The PEEP5 cmH2O group received PEEP of 5 cmH2O during pneumoperitoneum.Main Outcome MeasuresThe primary outcome was respiratory system compliance during laparoscopic surgery. Secondary outcomes were individualised PEEP levels, oxygenation, respiratory and haemodynamic status, and occurrence of postoperative pulmonary complications (PPCs) within 7 days.ResultsCompared with PEEP5 cmH2O, patients who received PEEPEIT had higher respiratory system compliance (mean values during surgery of 44.3 ± 11.3 vs. 31.9 ± 6.6, ml cmH2O-1; P < 0.001), lower driving pressure (11.5 ± 2.1 vs. 14.0 ± 2.4 cmH2O; P < 0.001), better oxygenation (mean PaO2/FiO2 427.5 ± 28.6 vs. 366.8 ± 36.4; P = 0.003), and less postoperative atelectasis (19.4 ± 1.6 vs. 46.3 ± 14.8 g of lung tissue mass; P = 0.003). Haemodynamic values did not differ significantly between the groups. No adverse effects were observed during surgery.ConclusionIndividualised PEEP by EIT may improve intra-operative pulmonary mechanics and oxygenation without impairing haemodynamic stability, and decrease postoperative atelectasis.Trial RegistrationChinese Clinical Trial Registry (www.chictr.org.cn) identifier: ChiCTR2100045166.Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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