| Objective:To explore the effect of dynamic and individualized positive end-expiratory pressure(PEEP)guided by driving pressure(ΔP)on postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:Fifty-one elderly patients undergoing elective laparoscopic surgery were randomized into three groups(n=17):the individualized PEEP group with ΔP titration(DV group),where PEEP was titrated gradually decreasing to the lowest ΔP and the titration procedure was repeated hourly,with additional titration procedures performed when performing predefined events potentially associated with alveolar collapse;the standard protective ventilation group(PV group),throughout the procedure using a fixed PEEP of 6 cmH2O;and the conventional ventilation group(CV group),where PEEP was 0 throughout the procedure.the primary index of this study was the atelectasis lung ultrasound score at the end of the procedure and 15 minutes after admission to the post-anesthesia recovery unit(PACU).Secondary indicators were perioperative oxygenation function,expiratory mechanics indices and the incidence of postoperative pulmonary complications.Results:The lung ultrasound scores of the DV group were significantly lower than those in the PV group and CV group(P<0.05),whereas there was no significant difference between the PV group and CV group(P>0.05).The lung static compliance(Cstat)and ΔP at all the intraoperative time points in the DV group were significantly better compared to the PV group and the CV group(P<0.05).Conclusions:Intraoperative titrated PEEP reduced postoperative lung atelectasis and improved respiratory mechanics in elderly patients undergoing laparoscopic surgery.Meanwhile,standard PEEP strategy is not superior to conventional ventilation in reducing postoperative pulmonary atelectasis in laparoscopic surgery. |
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