Effects of driving pressure-guided versus dynamic lung compliance-guided individualized PEEP mechanical ventilation on pulmonary function in patients undergoing laparoscopic radical resection of rectal cancer
ZHANG Xiaoyan
ZHANG Jingjing
YUE Caixia
YANG Qing
Abstract：Objective To explore the impact of driving pressure(DP)-guided versus dynamic lung compliance(Cdyn)-guided individualized positive end-expiratory pressure(PEEP)mechanical ventilation on pulmonary function in patients undergoing laparoscopic radical resection of rectal cancer.Methods A total of 100 patients who underwent elective laparoscopic radical resection for rectal cancer from August 2022 to December 2023 were selected and evenly divided into the DP group and the Cdyn group by random number table method.DP was used to determine the optimal PEEP in the DP group,and Cdyn was used to determine the optimal PEEP in the Cdyn group.Lung ultrasound scores(LUS)of the two groups before anesthesia induction(T0),before tracheal tube removal after surgery(T1),at 1 h after extubation(T2),and at 3 d after surgery(T3)were compared between the two groups,as well as peak airway pressure(Ppeak)plateau airway pressure(Pplat),oxygenation index(OI),DP,and Cdyn at 5 min after determining the optimal PEEP(T4),1 h after pneumoperitoneum establishment(T5),2 h after pneumoperitoneum establishment(T6),and 20 min after pneumoperitoneum completion(T7),serum levels of interleukin-6(IL-6)and Clara cell protein 16(CC16)at T0,T1,and at 1 d after surgery(T8),and the incidence of pulmonary complications within 7 d after surgery.Results At T1,T2,and T3,the LUS was lower in the Cdyn group than in the DP group(P＜0.01).At T5～T7,Ppeak,Pplat and DP were lower in the Cdyn group than in the DP group,and OI and Cdyn were higher in the Cdyn group than in the DP group(P＜0.05).At T1,the serum levels of IL-6 and CC6 were lower in the Cdyn group than in the DP group,and at T8,the serum level of IL-6 was lower in the Cdyn group than in the DP group(P＜0.05).The incidence of postoperative pulmonary complications was 10.00％(5/50)in the Cdyn group,and 14.00％(7/50)in the DP group,showing significant difference(P＞0.05).Conclusion Use of Cdyn to guide optimal PEEP mechanical ventilation can significantly improve intraoperative Cdyn in patients undergoing laparoscopic radical resection of rectal cancer,reduce DP,alleviate inflammatory responses,and enhance pulmonary function.
Keywords：rectal cancerlaparoscopic surgerygeneral anesthesiamechanical ventilationpositive end-expiratory pressuredriving pressuredynamic lung complianceoxygenation index
Publication Date：2025-11-28
Online Publishing Date：2025-12-11(First online date of this platform, not the publication date of the document)
Pages：6( 66-71 )