Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial
Abstract Higher intraoperative mechanical power (MP) is associated with increased postoperative pulmonary complications (PPCs). We hypothesised that periodic alveolar recruitment manoeuvres (PARM) alone, as an open-lung strategy for intraoperative protective ventilation, would reduce MP, thereby pot...
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Nature Portfolio
2025-07-01
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| Online Access: | https://doi.org/10.1038/s41598-025-13213-x |
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| author | Jing Guo Chu-Ling Liu Li-Zhen Zhang Jing Li Xiao-Ke Gu Tian-Shuo Wang Nan-Rong Zhang Hong Li |
| author_facet | Jing Guo Chu-Ling Liu Li-Zhen Zhang Jing Li Xiao-Ke Gu Tian-Shuo Wang Nan-Rong Zhang Hong Li |
| author_sort | Jing Guo |
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| description | Abstract Higher intraoperative mechanical power (MP) is associated with increased postoperative pulmonary complications (PPCs). We hypothesised that periodic alveolar recruitment manoeuvres (PARM) alone, as an open-lung strategy for intraoperative protective ventilation, would reduce MP, thereby potentially mitigating PPCs. Seventy-five non-obese participants were equally allocated to either alveolar recruitment manoeuvres every 30 min alone (PARM group), or medium positive end-expiratory pressure (PEEP) of 6–8 cmH2O alone (PEEP group), or a combination of medium PEEP and PARM (combination group). As a result, the median (interquartile range, IQR) MP in the PARM group was lower than in the other groups (PARM, 4.34 [3.58–5.27]; PEEP, 6.47 [5.83–7.74]; combination, 6.32 [5.16–7.36] J min−1; P < 0.001). The median difference (95% confidence interval, 95% CI) of MP between the PARM and control group (combined PEEP and combination) was 2.05 (1.34–2.74) J min−1, with a significant reduction (32.2%, P < 0.001) in the PARM group. However, no clinical benefit (such as PPCs) was observed despite these physiological improvements. In conclusion, PARM alone as an open-lung strategy for protective ventilation leads to a 32.2% reduction in MP, compared with medium PEEP alone or a combination of PARM and medium PEEP. The association between PARM and PPCs warrant further investigations. |
| format | Article |
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| institution | Kabale University |
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| language | English |
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| spelling | doaj-art-aebe7ac1d9274e47a4100e154281aa1e2025-08-20T04:02:45ZengNature PortfolioScientific Reports2045-23222025-07-0115111110.1038/s41598-025-13213-xOpen-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trialJing Guo0Chu-Ling Liu1Li-Zhen Zhang2Jing Li3Xiao-Ke Gu4Tian-Shuo Wang5Nan-Rong Zhang6Hong Li7Department of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityDepartment of Anaesthesia, The Sixth Affiliated Hospital, Sun Yat-sen UniversityAbstract Higher intraoperative mechanical power (MP) is associated with increased postoperative pulmonary complications (PPCs). We hypothesised that periodic alveolar recruitment manoeuvres (PARM) alone, as an open-lung strategy for intraoperative protective ventilation, would reduce MP, thereby potentially mitigating PPCs. Seventy-five non-obese participants were equally allocated to either alveolar recruitment manoeuvres every 30 min alone (PARM group), or medium positive end-expiratory pressure (PEEP) of 6–8 cmH2O alone (PEEP group), or a combination of medium PEEP and PARM (combination group). As a result, the median (interquartile range, IQR) MP in the PARM group was lower than in the other groups (PARM, 4.34 [3.58–5.27]; PEEP, 6.47 [5.83–7.74]; combination, 6.32 [5.16–7.36] J min−1; P < 0.001). The median difference (95% confidence interval, 95% CI) of MP between the PARM and control group (combined PEEP and combination) was 2.05 (1.34–2.74) J min−1, with a significant reduction (32.2%, P < 0.001) in the PARM group. However, no clinical benefit (such as PPCs) was observed despite these physiological improvements. In conclusion, PARM alone as an open-lung strategy for protective ventilation leads to a 32.2% reduction in MP, compared with medium PEEP alone or a combination of PARM and medium PEEP. The association between PARM and PPCs warrant further investigations.https://doi.org/10.1038/s41598-025-13213-xAlveolar recruitment manoeuvreLaparoscopic anterior resectionLung injury biomarkerMechanical powerOpen-lung strategyPositive end-expiratory pressure |
| spellingShingle | Jing Guo Chu-Ling Liu Li-Zhen Zhang Jing Li Xiao-Ke Gu Tian-Shuo Wang Nan-Rong Zhang Hong Li Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial Scientific Reports Alveolar recruitment manoeuvre Laparoscopic anterior resection Lung injury biomarker Mechanical power Open-lung strategy Positive end-expiratory pressure |
| title | Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial |
| title_full | Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial |
| title_fullStr | Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial |
| title_full_unstemmed | Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial |
| title_short | Open-lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection: a randomised controlled trial |
| title_sort | open lung strategies and mechanical power during protective ventilation for laparoscopic anterior resection a randomised controlled trial |
| topic | Alveolar recruitment manoeuvre Laparoscopic anterior resection Lung injury biomarker Mechanical power Open-lung strategy Positive end-expiratory pressure |
| url | https://doi.org/10.1038/s41598-025-13213-x |
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