The effect of driven pressure-guided individualized PEEP on postoperative atelectasis in elderly patients undergoing laparoscopic hernia repair:a randomized controlled trial

CONG Liang; SHEN Yan; LIU Yu; LUO Shengzhen; LI Yongwang; YU Yanhui

doi:10.3969/j.issn.2096-2681.2026.01.010

Abstract：Objective To investigate the effect of driving pressure-guided individualized positive end-expiratory pressure(PEEP)ventilation on postoperative atelectasis in elderly patients undergoing laparoscopic hernia repair.Methods A total of 80 elderly patients of both sexes,aged≥60 years,of American Society of Anesthesiologists(ASA)physical status Ⅰ-Ⅲ,with body mass index(BMI)of 18.5-29.9 kg/m2 undergoing laparoscopic hernia repair at Hulun Buir People's Hospital,from January to December 2023 were selected.The final research data were divided into the conventional PEEP group(group C,n=40)and the driving pressure-guided individualized PEEP group(group P,n=40)according to the random number table method.After the establishment of pneumoperitoneum at the beginning of the operation,PEEP was set at 5 cmH2O in Group C,while in Group P,individualized PEEP was titrated based on driving pressure.The titration method was as follows:PEEP was increased from 4 cmH2O to 12 cmH2O in 2 cmH2O increments,and each PEEP level was maintained for 10 respiratory cycles.The airway plateau pressure(Pplat)at the last respiratory cycle was recorded,and the driving pressure was calculated.The PEEP value corresponding to the minimum driving pressure was determined as the optimal individualized PEEP for the patient and maintained until the end of the operation.The lung ultrasound score(LUS)was recorded at three time points:before anesthesia(T0),before leaving the recovery room(T4),and 24 h after extubation(T5).The driving pressure was recorded at two time points:5 min after pneumoperitoneum establishment(T1),30 min after pneumoperitoneum establishment(T2),and at the end of the operation when the pneumoperitoneum was released(T3).The operation time,intraoperative blood loss,urine output,fluid infusion volume,intraoperative peak airway pressure(Ppeak),Pplat,and dynamic lung compliance(Cdyn)were recorded for both groups.The PEEP values,intraoperative pulse oxygen saturation(SpO2),postoperative visual analog scale(VAS)pain score,and hospital stay were also recorded.The primary outcome was the LUS score 24 h after extubation;The secondary outcomes included intraoperative driving pressure,Cdyn,and postoperative complications.Results The LUS score at T5 was lower in group P than that in group C(1.65±1.05 vs 3.40±1.55,P＜0.001);the intraoperative driving pressure was lower in group P at T1(13 vs 17 cm H2O,P＜0.001),T2(13 vs 17 cmH2O,P＜0.001),and T3(8 vs 10 cmH2O,P＜0.001).The Ppeak and Pplat in group C were significantly higher than those in group P at T2(P＜0.05);the intraoperative Cdyn was higher in group C at T1(32.18±4.15 vs 26.49±4.99 mL/cmH2O,P＜0.001),T2(30.95±3.90 vs 24.83±4.53 mL/cmH2O,P＜0.001),and T3(56.88±10.89 vs 41.24±7.83 mL/cmH2O,P＜0.001).The median individualized PEEP value determined by driving pressure-guided titration was 8(6-8)cmH2O,while the conventional PEEP was 5 cmH2O,with a statistically significant difference(P＜0.05).There was no statistically significant difference in the postoperative VAS score(P＞0.05)or hospital stay(P＞0.05)between the two groups.Conclusion Intraoperative individualized PEEP settings guided by driving pressure can reduce the driving pressure during surgery and the postoperative lung ultrasound score in elderly patients undergoing hernia repair,decrease the severity of atelectasis.This leads to a reduction in the incidence of postoperative pulmonary complications and a shorter postoperative convalescence.