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Robot-assisted laparoscopic radical prostatectomy (RALP) requires steep Trendelenburg positioning and pneumoperitoneum, which adversely affect respiratory mechanics and may lead to impaired postoperative oxygenation.
Mechanical power (MP) has recently emerged as a comprehensive parameter reflecting the total energy delivered from the ventilator to the respiratory system and may be associated with ventilator-induced lung injury.
This prospective randomized controlled trial aims to evaluate whether a mechanical power-targeted ventilation strategy improves postoperative oxygenation compared to standard ventilation in patients undergoing RALP.
The primary outcome is the oxygenation index (OSI) at the postoperative second hour. Secondary outcomes include PaO₂/FiO₂ ratio, postoperative pulmonary complications, and length of hospital stay.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mechanical Power-Targeted Ventilation | Experimental | Patients receive ventilation adjusted to achieve the lowest possible mechanical power (≤14 J/min) by titrating PEEP and respiratory rate. |
|
| Standard Ventilation | Active Comparator | Patients receive conventional ventilation with fixed PEEP (5 cmH₂O) and routine ventilator settings. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mechanical Power-Targeted Ventilation | Procedure | Ventilation adjusted to achieve the lowest possible mechanical power (≤14 J/min) using titration of PEEP and respiratory rate. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Oxygenation Index (OSI) | OSI calculation: OSI = FiO₂ × MAP × 100 / SpO₂ | postoperative 2nd hour |
| Measure | Description | Time Frame |
|---|---|---|
| PaO₂/FiO₂ ratio | Intraoperative period and postoperative 2 hours | |
| Postoperative pulmonary complications (PPC) | Within 7 postoperative days | |
| Intraoperative respiratory mechanics |
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Inclusion Criteria:
Exclusion Criteria:
Severe pulmonary disease (advanced COPD, ILD)
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Betül Güven Aytaç, Assos Prof | Contact | 0905073578351 | drbguven@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Bilkent City Hospital | Ankara | Turkey (Türkiye) |
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Single (Outcome Assessor
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| Standard Ventilation | Procedure | Conventional ventilation strategy with fixed PEEP (5 cmH₂O) and routine settings. |
|
Dynamic compliance (Cdyn, mL/cmH₂O) Static compliance (Cstat, mL/cmH₂O) Peak airway pressure (Ppeak, cmH₂O) Plateau pressure (Pplat, cmH₂O) Driving pressure (ΔP = Pplat - PEEP, cmH₂O) Mean airway pressure (MAP, cmH₂O) Airway resistance |
| During surgery (from intubation to extubation) |
| Mechanical power changes | During surgery (at predefined intraoperative time points) |