Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies
Abstract Background Pediatric laparoscopic surgery often induces atelectasis due to pneumoperitoneum, postural changes, and immature respiratory physiology, increasing postoperative pulmonary complications (PPCs). Fixed PEEP may fail to address perioperative variability. This study evaluated whether...
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BMC
2025-08-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-025-03274-w |
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| author | Ling-hui Guo Jian-gang Li Ming Zhang Ji-lin Wu Chao Xie Yue Lu Na Li Bo Feng Li-ming Cheng |
| author_facet | Ling-hui Guo Jian-gang Li Ming Zhang Ji-lin Wu Chao Xie Yue Lu Na Li Bo Feng Li-ming Cheng |
| author_sort | Ling-hui Guo |
| collection | DOAJ |
| description | Abstract Background Pediatric laparoscopic surgery often induces atelectasis due to pneumoperitoneum, postural changes, and immature respiratory physiology, increasing postoperative pulmonary complications (PPCs). Fixed PEEP may fail to address perioperative variability. This study evaluated whether dynamic PEEP adjustment reduces atelectasis and improves oxygenation. Methods Children at moderate or high risk of PPCs undergoing elective laparoscopic surgery were randomized into two groups. Group A had driving pressure-guided individualized PEEP titration at three specified time points: after intubation, before pneumoperitoneum initiation, and after pneumoperitoneum completion. Group B had individualized PEEP titration only after intubation, with this PEEP maintained until the end of ventilation. Both groups received alveolar recruitment maneuvers (ARMs). Observations were conducted at 5 min after tracheal intubation (T1), 20 min post-pneumoperitoneum (T2), 60 min post-pneumoperitoneum (T3), at the end of surgery (T4), and at extubation (T5). The primary outcome were intraoperative lung ultrasound score. Secondary outcomes included incidence of atelectasis, oxygenation index, peak airway pressure, plateau pressure, PEEP, driving pressure, dynamic lung compliance, mean arterial pressure, and heart rate. Results At T4 and T5, Group A showed significantly lower subpleural consolidation scores, total lung ultrasound scores, and atelectasis rates versus Group B (P < 0.05). Oxygenation indices in Group A were higher at T3–T5 (P < 0.05). Post-pneumoperitoneum, Group A’s median PEEP increased to 8 cmH2O (vs. Group B), with lower driving pressure and higher dynamic compliance (P < 0.05). Hemodynamic parameters showed no intergroup differences (P > 0.05). Conclusion Driving pressure-guided dynamic PEEP titration reduces postoperative lung ultrasound abnormalities and atelectasis while improving oxygenation and respiratory mechanics in pediatric laparoscopy, without compromising hemodynamic stability. This strategy supports personalized PEEP optimization. Trial registration This trial was registered on Clinical Trials.gov (Registration No. ChiCTR2300070193, Registration date: 2023-04-04). The trial was retrospectively registered as enrollment began prior to registration. |
| format | Article |
| id | doaj-art-2dc2e562d5e84cfcacd7b6309eeb2929 |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Anesthesiology |
| spelling | doaj-art-2dc2e562d5e84cfcacd7b6309eeb29292025-08-24T11:47:30ZengBMCBMC Anesthesiology1471-22532025-08-0125111010.1186/s12871-025-03274-wDriving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategiesLing-hui Guo0Jian-gang Li1Ming Zhang2Ji-lin Wu3Chao Xie4Yue Lu5Na Li6Bo Feng7Li-ming Cheng8Department of Anesthesiology, Kunming Children’s HospitalDepartment of Anesthesiology, Kunming Medical University Affiliated Qujing HospitalDepartment of Anesthesiology, Kunming Children’s HospitalDepartment of Anesthesiology, Kunming Children’s HospitalSurgical Intensive Care Unit, Kunming Children’s HospitalDepartment of Anesthesiology, Kunming Children’s HospitalDepartment of Anesthesiology, 920th Hospital of Joint Logistics Support ForceDepartment of Anesthesiology, Kunming Children’s HospitalDepartment of Anesthesiology, Kunming Children’s HospitalAbstract Background Pediatric laparoscopic surgery often induces atelectasis due to pneumoperitoneum, postural changes, and immature respiratory physiology, increasing postoperative pulmonary complications (PPCs). Fixed PEEP may fail to address perioperative variability. This study evaluated whether dynamic PEEP adjustment reduces atelectasis and improves oxygenation. Methods Children at moderate or high risk of PPCs undergoing elective laparoscopic surgery were randomized into two groups. Group A had driving pressure-guided individualized PEEP titration at three specified time points: after intubation, before pneumoperitoneum initiation, and after pneumoperitoneum completion. Group B had individualized PEEP titration only after intubation, with this PEEP maintained until the end of ventilation. Both groups received alveolar recruitment maneuvers (ARMs). Observations were conducted at 5 min after tracheal intubation (T1), 20 min post-pneumoperitoneum (T2), 60 min post-pneumoperitoneum (T3), at the end of surgery (T4), and at extubation (T5). The primary outcome were intraoperative lung ultrasound score. Secondary outcomes included incidence of atelectasis, oxygenation index, peak airway pressure, plateau pressure, PEEP, driving pressure, dynamic lung compliance, mean arterial pressure, and heart rate. Results At T4 and T5, Group A showed significantly lower subpleural consolidation scores, total lung ultrasound scores, and atelectasis rates versus Group B (P < 0.05). Oxygenation indices in Group A were higher at T3–T5 (P < 0.05). Post-pneumoperitoneum, Group A’s median PEEP increased to 8 cmH2O (vs. Group B), with lower driving pressure and higher dynamic compliance (P < 0.05). Hemodynamic parameters showed no intergroup differences (P > 0.05). Conclusion Driving pressure-guided dynamic PEEP titration reduces postoperative lung ultrasound abnormalities and atelectasis while improving oxygenation and respiratory mechanics in pediatric laparoscopy, without compromising hemodynamic stability. This strategy supports personalized PEEP optimization. Trial registration This trial was registered on Clinical Trials.gov (Registration No. ChiCTR2300070193, Registration date: 2023-04-04). The trial was retrospectively registered as enrollment began prior to registration.https://doi.org/10.1186/s12871-025-03274-wIndividualized positive end-expiratory pressureAtelectasisPostoperative pulmonary complicationsLaparoscopic surgeryChildren |
| spellingShingle | Ling-hui Guo Jian-gang Li Ming Zhang Ji-lin Wu Chao Xie Yue Lu Na Li Bo Feng Li-ming Cheng Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies BMC Anesthesiology Individualized positive end-expiratory pressure Atelectasis Postoperative pulmonary complications Laparoscopic surgery Children |
| title | Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies |
| title_full | Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies |
| title_fullStr | Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies |
| title_full_unstemmed | Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies |
| title_short | Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies |
| title_sort | driving pressure guided dynamic peep titration reduces atelectasis and improves oxygenation in pediatric laparoscopy a randomized trial on personalized ventilation strategies |
| topic | Individualized positive end-expiratory pressure Atelectasis Postoperative pulmonary complications Laparoscopic surgery Children |
| url | https://doi.org/10.1186/s12871-025-03274-w |
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