Clinical Study On The Effect Of Individualized PEEP Setting On Respiratory Function In Patients Undergoing Robotic Surgery

Objective:This study aims to compare the effect of traditional lung-protective ve ntilation strategies and individualized PEEP titration on the improvement of respira tory function in patients with da Vinci robotic-assisted laparoscopic surgery,so as to guide the selection of more appropriate ventilation strategies,improve the qual ity of postoperative recovery,and meet the needs of accelerated rehabilitation surg ery（ERAS）.Methods:A total of 40 patients who underwent da Vinci robotic-assisted laparosc opic surgery in the First Affiliated Hospital of China Medical University since Au gust 2021 were selected.They were randomly divided into small tidal volume co mbined with fixed PEEP group（T group）and individualized PEEP group（I grou p）.PEEP=5cm H₂O in group T;Group I guided PEEP setting according to lung c ompliance every hour after endotracheal intubation and after pneumoperitoneum est ablishment,and looked for the most suitable PEEP.After endotracheal intubation（T₁）,10 mins after pneumoperitoneum establishment（T₂）,1 h after pneumoperiton eum establishment（T₃）,2 hrs after pneumoperitoneum establishment（T₄）,and 10mins of pneumoperitoneum were released（T₅）,blood gas analysis was performed,oxygen partial pressure（PaO₂）,carbon dioxide partial pressure（Pa CO₂）,oxygenat ion index（OI）calculated,dynamic lung compliance（Cdyn）,and the use of vasoa ctive drugs in each group.The occurrence of pulmonary complications three days after surgery and discharge time were recorded.Results:Compared with group T,PaO₂,OI and Cydn increased in group I at T₂-T₅（p<0.05）;Pa CO₂decreased in group I（p<0.05）in group T₅;compared with gr oup T,group I increased at T₂,group I MAP decreased at T₃（p<0.05）,there wa s no significant difference in the rest of the time points（p>0.05）,there was no si gnificant difference in the use of vasoactive drugs between the two groups,postop erative pulmonary complications decreased in group I（p<0.05）,and there was no significant difference in discharge time between the two groups.Conclusions:1.For patients undergoing robotic surgery,the high position of head and hip and the establishment of pneumoperitoneum will affect intraoperative ventilation,compared with small tidal volume combined with fixed PEEP,intraoperative individualized PEEP according to dynamic lung compliance can optimize intraoperative lung function,effectively improve lung dynamic compliance,and improve intraoperative oxygenation;2.Intraoperative individualized setting of optimal PEEP can reduce the incidence of postoperative cough and sputum production and hypoxemia in robotic surgery patients,and improve the prognosis of patients.Meets the requirements of accelerated rehabilitation surgery（ERAS）and is of guiding clinical significance for the selection of appropriate intraoperative ventilation strategies.