Mechanical Power and Driving Pressure Exposure in Laparoscopic Surgery

Time-Dependent Exposure to Intraoperative Mechanical Power and Driving Pressure and Postoperative Pulmonary Outcomes in Laparoscopic Surgery

Postoperative pulmonary complications (PPCs) remain an important cause of morbidity after abdominal surgery. Intraoperative mechanical ventilation may contribute to lung injury through the mechanical load applied to the respiratory system. Mechanical power (MP) and driving pressure (DP) have emerged as integrative parameters reflecting the total ventilatory burden delivered to the lungs.

This prospective observational study aims to evaluate the association between time-dependent exposure to intraoperative mechanical power and driving pressure and postoperative pulmonary outcomes in patients undergoing elective laparoscopic abdominal surgery. Ventilatory parameters will be recorded at predefined intervals during routine clinical care, and MP and DP will be calculated without altering clinical management. The primary objective is to assess whether longer exposure to elevated ventilatory load is associated with the development of postoperative pulmonary complications.

Inclusion Criteria:

• Age ≥ 18 years
• Scheduled for elective laparoscopic abdominal surgery under general anesthesia
• Intraoperative mechanical ventilation with volume-controlled ventilation
• Provision of written informed consent

Exclusion Criteria:

• Emergency surgery
• Conversion to open surgery
• Preoperative invasive or noninvasive mechanical ventilation
• Intraoperative major complications requiring substantial deviation from routine ventilation management
• Incomplete intraoperative or postoperative data
• Refusal or inability to provide informed consent