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Effect of dynamic lung compliance-guided positive end-expiratory pressure on postoperative pulmonary complications following thoracoscopic lobectomy: a randomized controlled trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: The risk of postoperative pulmonary complications is significantly increased in patients undergoing video-assisted thoracic surgical lobectomy. Individualized positive end-expiratory pressure (PEEP) is extensively employed to optimize respiratory mechanics and enhance oxygenation during one-lung ventilation (OLV). However, there is no consensus regarding the optimal level of positive end-expiratory pressure and its effects during OLV. Therefore, we designed a randomized controlled trial to assess whether titrating PEEP to the maximum dynamic lung compliance in patients undergoing lung resection surgery impacts the occurrence of postoperative pulmonary complications (PPCs). METHODS: In this randomized controlled trial, patients undergoing thoracoscopic lobectomy were randomly assigned to either a dynamic lung compliance group that received individualized PEEP guided by the maximum dynamic pulmonary compliance or a conventional ventilation group with a fixed PEEP of 5 cm H2O. The primary outcome was a composite of PPCs occurring within seven days, as defined by the European Perioperative Clinical Outcome criteria. Secondary outcomes included PEEP, Cdyn, PaO2, serum concentrations of IL-6 and TNF-α, and the duration of postoperative hospital stays. RESULTS: One hundred patients were enrolled. The optimal PEEP obtained in the dynamic lung compliance group was 9.04 ± 1.83 cm H2O. Patients in the conventional ventilation group experienced 38% postoperative pulmonary complications versus 20% in the dynamic lung compliance group compared with the control group (P < 0.01). The serum Interleukin-10 concentrations at T5 in the dynamic lung compliance group were higher than those in the ventilation group (P = 0.046), and the serum Interleukin-1 concentrations at T5 and T6 in the dynamic lung compliance group were lower than those in the ventilation group (P < 0.01). CONCLUSIONS: In patients undergoing video-assisted thoracoscopic lobectomy for lung resection with maximum dynamic compliance-guided positive end-expiratory pressure (PEEP), the incidence of postoperative pulmonary complications (PPCs) within 7 days was significantly lower compared to those receiving a PEEP of 5 cm H2O. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trials Registry on 04/07/2021 with registration number ChiCTR2100048201.

Source: BMC Anesthesiology

DOI: 10.1186/s12871-025-03183-y