• Muqiao Cheng, Fengying Xu, Wei Wang, Weiwei Li, Ran Xia, Haiying Ji, Shunan Lv, Xueyin Shi, and Chengmi Zhang.
• Department of Anesthesiology and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
• Minerva Anestesiol. 2024 Nov 1; 90 (11): 969978969-978.

BackgroundThe reduction in functional residual capacity (FRC) is a significant pathological factor in the development of postoperative pulmonary complications. Appropriate positive end-expiratory pressure (PEEP) is critical to preserve FRC during mechanical ventilation. Our previous study suggests that using driving pressure-guided PEEP can reduce postoperative pulmonary complications. In this study, we hypothesize that individualized PEEP can increase immediate postoperative FRC and improve lung ventilation.MethodsThis single-centered, randomized controlled trial included a total of 91 patients scheduled for laparoscopic surgery for colorectal carcinoma. Patients were randomly assigned to receive individualized PEEP guided by minimum driving pressure or a fixed PEEP of six cmH2O. The primary outcome was postoperative FRC. Secondary outcomes included the incidence of postoperative pulmonary complications, postoperative Oxygenation Index, alveolar-arterial oxygen tension difference (PA-aO2), intrapulmonary shunt (QS/QT), and Respiratory Index, as well as lung ventilation measured by electrical impedance tomography.ResultsThe median value of PEEP in the individualized group was 14 cmH2O, with an interquartile range of 12-14 cmH2O. The postoperative FRC was significantly higher in the individualized PEEP group than that in the PEEP six cmH2O group (32.8 [12.8] vs. 25.0 [12.6] mL/kg, P=0.004). Patients receiving driving pressure-guided PEEP also had significantly higher Oxygenation Index, better ventilation distribution, and lower PA-aO2, QS/QT, and Respiratory Index.ConclusionsDriving pressure-guided PEEP can preserve postoperative FRC and provide better ventilation and oxygenation for patients undergoing laparoscopic colorectal surgery.

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