Effect Of Cdyn Guided Individualized Positive End-expiratory Pressure Ventilation On Extravascular Lung Water Of Patients With Robot-assisted Radical Prostatectomy

Objective:To evaluate the effect of Cdyn-directed individualized PEEP titration on extravascular lung water in patients undergoing robotic radical prostatectomy.Methods:40 patients with radical prostatectomy underwent elective surgery,aged 6580 years,Body Mass Index 1928 kg/m2,and ASA grade II or III.The random number table method was used to divide into two groups?n=20?:control group?group C?and PEEP group?group P?.After induction of anesthesia and endotracheal intubation,PCV-VG mode ventilation was used.The tidal volume was 8 ml/kg PBW,the ventilation frequency was 12beats/min,the inhaled oxygen concentration was 50%,and the respiratory ratio was 1:2.The frequency is such that PETCO2 is maintained at 30 to 45 mmHg.For group P,immediately after the end of endotracheal intubation,the Trendelenburg position was established and the supine position was restored,starting from the lowest PEEP allowed by the machine,increasing 2 cmH2O every 4 min until the maximum Cdyn was obtained,optimal.PEEP were titrated in these time point;Group C does not set PEEP.In group P,after the establishment of an invasive artery?T1?,10 min after the first successful PEEP titration?T2?,10 min after the second titration of PEEP?T3?,1 h after T3?T4?,2 h after T2?T5?,10 min after successful thrid titrations of PEEP?T6?and 30 min after tracheal extubation?T7?;In group C,immediately after the establishment of an invasive artery?T1?,10 min after end of tracheal intubation?T2?,10 minutes after the establishment of the Trendelenburg position?T3?,1 hour after T3?T4?,2 hours?T5?,10 minutes after the supine position?T6?,30 minutes after tracheal extubation?T7?;Record T1T7 respectively basic vital signs such as leveling Pulse oximetry?SpO2?,heart rate?HR?,brachial artery systolic pressure?rSBP?,brachial artery diastolic pressure?rSDP?,mean arteries pressure?MAP?,and extract arterial blood to calculate the corresponding oxygenation index?OI?.B-line scoring was performed on the lungs under T1 and T7,then the B-line score was recorded.The B-line scores,oxygenation index,and vital signs at each time point were compared between the two groups.Results:Compared with T1,the B-line scores of T7 increased in 2 groups,SpO2 decreased at T7,OI increased at T233 and OI decreased at T57in group C,OI decreased at T6 in group P?P<0.05?.Compared with group C,SpO2 and the B-line score decreased in T7 and the OI increased in T57for group P?P<0.05?.ConclusionCdyn-directed individualized PEEP titration can reduce the formation of extravascular lung water and improve lung oxygenation founction in patients with robotic radical prostatectomy.