Effects of driving pressure-guided ventilation by individualized positive end-expiratory pressure on oxygenation undergoing robot-assisted laparoscopic radical prostatectomy: a randomized controlled clinical trial.

Purpose: Patients with robot-assisted laparoscopic radical prostatectomy (RALP) need to be placed in Trendelenburg position, which results in cranial displacement of the diaphragm and decreases functional residual capacity and pulmonary compliance. Positive end-expiratory pressure (PEEP) can increase ventilation in the dorsal area, reduce the occurrence of atelectasis and improve oxygenation. However, due to individual differences, inappropriate PEEP will cause lung injury and even hemodynamic instability. Therefore, our study is to evaluate the efficacy of individualized PEEP in RALP.

Methods: We randomly recruited 48 patients and divided them into driving pressure-guided individualized PEEP group (P group, individualized PEEP) or traditional lung-protective ventilation strategy group (C group, tidal volume 8 mL/kg combined with PEEP of 5cmHO). The primary outcome was the PaO/FiO before extubation. The secondary outcomes included individualized PEEP values in the P group, the results of arterial blood gas analysis, respiratory mechanics parameters and vital sign parameters. Other measurements included intraoperative vasoactive drug dosage, length of stay, postoperative SpO, leukocyte count, temperature, serum inflammatory factors and soluble receptor for advanced glycation end products (sRAGE).

Results: Individualized PEEP improved the PaO/FiO before extubation (P = 0.034) and decreased driving pressure (P = 0.011). The PEEP valued in the P group was 14 [10-14] cmHO. The lung compliance of the P group was significantly higher than that in the C group (P = 0.013). There was no significant difference in other measurements.

Conclusions: Individualized PEEP could improve PaO/FiO in patients who underwent RALP and do not increase the dosage of intraoperative vasoactive drug and the release of inflammatory factors.

Trial Registration: www.chictr.org.cn (registration no. ChiCTR2100047271).