Objective To explore effect of individualized positive end expiratory pressure (PEEP) guided by driving pressure on lung protection in patients undergoing laparoscopic surgery
Methods Forty patients undergoing elective laparoscopic radical resection of colorectal cancer were randomly divided into experimental group (individualized PEEP) and control group (PEEP 5 cmH2O), with 20 cases in each group. The control group was given PEEP of 5 cmH2O PEEP, while the experimental group was titrated at 4, 6, 8, 10 and 12 cmH2O incrematically, 12 respiration cycles were performed each time, and the driving pressure of each PEEP value in the last respiration cycle was recorded. After titration, the PEEP with the lowest driving pressure was selected and continued until extubation. Tidal volume (VT), peak airway pressure (Ppeak), airway platform pressure (Pplat) and PEEP were recorded immediately after the establishment of pneumoperitonic-Trendelenburg position (T0), 30 minutes after administration of PEEP (T1) and the end of operation (T2); dynamic lung compliance (CDyn) was calculated. The arterial oxygen partial pressurespa(O2) of patients at T0, T1, T2 and 24 hours after surgery (T3) were recorded, and the oxygenation index (OI) was calculated; peripheral venous blood was collected at T0, T2 and T3, respectively, and the concentrations of interleukin-6 (IL-6) as well as clara cell protein 16 (CC16) were determined.
Results Compared with the control group, Cdyn was significantly increased from T1 to T2, and OI was significantly increased from T1 to T3(P < 0.05); the concentration of IL-6 in experimental group was significantly decreased from T2 to T3, and the concentration of CC16 was significantly decreased at T2 (P < 0.05).
Conclusion Individualized PEEP guided by driving pressure provides lung protection in patients undergoing laparoscopic radical resection of colorectal cancer.
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