Zhou Yihu, Song Zhenghuan, Cai Jiaqin, Huang Shiyi, Zhu Mengyue, Jiang Yueyi, Bao Qinyu, Zhang Lin, Jin Ruyi, Gu Lianbing, Tan Jing
The Affiliated Cancer Hospital of Nanjing Medical University, Yangzhou, Jiangsu, 210009, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Yangzhou, Jiangsu, 221004, China.
BMC Anesthesiol. 2025 Jul 1;25(1):306. doi: 10.1186/s12871-025-03183-y.
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).
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 HO. 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, PaO, serum concentrations of IL-6 and TNF-α, and the duration of postoperative hospital stays.
One hundred patients were enrolled. The optimal PEEP obtained in the dynamic lung compliance group was 9.04 ± 1.83 cm HO. Patients in the conventional ventilation group experienced 38% postoperative pulmonary complications versus 20% in the dynamic lung compliance group compared with the control group ( < 0.01). The serum Interleukin-10 concentrations at T in the dynamic lung compliance group were higher than those in the ventilation group ( = 0.046), and the serum Interleukin-1 concentrations at T and T in the dynamic lung compliance group were lower than those in the ventilation group ( < 0.01).
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 HO.
This study was registered at the Chinese Clinical Trials Registry on 04/07/2021 with registration number ChiCTR2100048201.
The online version contains supplementary material available at 10.1186/s12871-025-03183-y.
在接受电视辅助胸腔镜肺叶切除术的患者中，术后肺部并发症的风险显著增加。个体化呼气末正压（PEEP）被广泛应用于优化呼吸力学并在单肺通气（OLV）期间提高氧合。然而，关于呼气末正压的最佳水平及其在OLV期间的作用尚无共识。因此，我们设计了一项随机对照试验，以评估在肺切除手术患者中将PEEP滴定至最大动态肺顺应性是否会影响术后肺部并发症（PPCs）的发生。
在这项随机对照试验中，接受胸腔镜肺叶切除术的患者被随机分配至动态肺顺应性组，该组接受以最大动态肺顺应性为指导的个体化PEEP，或传统通气组，其固定PEEP为5 cmH₂O。主要结局是根据欧洲围手术期临床结局标准定义的7天内发生的PPCs的复合情况。次要结局包括PEEP、Cdyn、PaO₂、血清白细胞介素-6和肿瘤坏死因子-α浓度以及术后住院时间。
共纳入100例患者。动态肺顺应性组获得的最佳PEEP为9.04±1.83 cmH₂O。与对照组相比，传统通气组患者术后肺部并发症发生率为38%，而动态肺顺应性组为20%（P<0.01）。动态肺顺应性组T₁时的血清白细胞介素-10浓度高于通气组（P = 0.046），动态肺顺应性组T₁和T₂时的血清白细胞介素-1浓度低于通气组（P<0.01）。
在接受电视辅助胸腔镜肺叶切除术进行肺切除且采用最大动态顺应性指导呼气末正压（PEEP）的患者中，与接受5 cmH₂O PEEP的患者相比，7天内术后肺部并发症（PPCs）的发生率显著降低。
本研究于2021年7月4日在中国临床试验注册中心注册，注册号为ChiCTR2100048201。
在线版本包含可在10.1186/s12871-025-03183-y获取的补充材料。
