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Robotic surgery requires pneumoperitoneum and steep Trendelenburg positioning, which significantly impair respiratory mechanics and increase the risk of postoperative pulmonary complications.
Positive end-expiratory pressure (PEEP) is a key determinant of lung recruitment; however, fixed PEEP strategies may not be optimal for all patients. Individualized PEEP titration strategies, including incremental and decremental approaches, may better optimize lung mechanics.
This randomized controlled trial aims to compare the effects of incremental, decremental, and fixed PEEP strategies on cumulative mechanical power (MP-AUC) and postoperative oxygenation in patients undergoing robotic surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fixed PEEP | Active Comparator | Ventilation with constant PEEP of 5 cmHâ‚‚O throughout surgery. |
|
| Decremental PEEP | Experimental | PEEP is gradually decreased to identify the level associated with the lowest driving pressure or lowest mechanical power. |
|
| Incremental PEEP | Experimental | PEEP is gradually increased to determine the optimal level corresponding to the lowest driving pressure or mechanical power. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fixed PEEP Ventilation | Procedure | Patients receive mechanical ventilation with a constant positive end-expiratory pressure (PEEP) of 5 cmHâ‚‚O throughout the surgical procedure. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Cumulative Mechanical Power (MP-AUC) | Total energy delivered to the respiratory system during surgery | During surgery (from intubation to extubation) |
| Measure | Description | Time Frame |
|---|---|---|
| PaOâ‚‚/FiOâ‚‚ ratio | Intraoperative period and postoperative period (within 2 hours) | |
| Oxygenation Index (OSI) | Postoperative 2 hours | |
| Postoperative Pulmonary Complications (PPC) |
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Inclusion Criteria:
Exclusion Criteria:
COPD GOLD ≥2
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| Decremental PEEP Strategy | Procedure | PEEP is gradually decreased from a higher level to determine the optimal PEEP associated with the lowest driving pressure or lowest mechanical power, and this level is maintained during surgery. |
|
| Incremental PEEP Strategy | Procedure | PEEP is gradually increased from a lower level to identify the optimal PEEP corresponding to the lowest driving pressure or mechanical power, and this level is maintained during surgery. |
|
| Within 7 postoperative days |