Guo Ling-Hui, Li Jian-Gang, Zhang Ming, Wu Ji-Lin, Xie Chao, Lu Yue, Li Na, Feng Bo, Cheng Li-Ming
Department of Anesthesiology, Kunming Children's Hospital, Kunming, Yunnan, 650100, China.
Department of Anesthesiology, Kunming Medical University Affiliated Qujing Hospital, Yunnan, China.
BMC Anesthesiol. 2025 Aug 20;25(1):412. doi: 10.1186/s12871-025-03274-w.
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.
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.
At T4 and T5, Group A showed significantly lower subpleural consolidation scores, total lung ultrasound scores, and atelectasis rates versus Group B ( < 0.05). Oxygenation indices in Group A were higher at T3–T5 ( < 0.05). Post-pneumoperitoneum, Group A’s median PEEP increased to 8 cmHO (vs. Group B), with lower driving pressure and higher dynamic compliance ( < 0.05). Hemodynamic parameters showed no intergroup differences ( > 0.05).
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.
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.
The online version contains supplementary material available at 10.1186/s12871-025-03274-w.
小儿腹腔镜手术常因气腹、体位改变和未成熟的呼吸生理而导致肺不张，增加术后肺部并发症（PPCs）。固定呼气末正压通气（PEEP）可能无法应对围手术期的变化。本研究评估动态PEEP调整是否能减少肺不张并改善氧合。
将有中度或高度PPCs风险且接受择期腹腔镜手术的儿童随机分为两组。A组在三个特定时间点进行驱动压引导的个体化PEEP滴定：插管后、气腹开始前和气腹完成后。B组仅在插管后进行个体化PEEP滴定，并维持该PEEP直至通气结束。两组均接受肺泡复张手法（ARMs）。在气管插管后5分钟（T1）、气腹后20分钟（T2）、气腹后60分钟（T3）、手术结束时（T4）和拔管时（T5）进行观察。主要结局是术中肺部超声评分。次要结局包括肺不张发生率、氧合指数、气道峰压、平台压、PEEP、驱动压、动态肺顺应性、平均动脉压和心率。
在T4和T5时，A组的胸膜下实变评分、全肺超声评分和肺不张发生率均显著低于B组（<0.05）。A组在T3至T5时的氧合指数较高（<0.05）。气腹后，A组的PEEP中位数增加至8 cmH₂O（与B组相比），驱动压较低，动态顺应性较高（<0.05）。血流动力学参数组间无差异（>0.05）。
驱动压引导的动态PEEP滴定可减少小儿腹腔镜手术后肺部超声异常和肺不张，同时改善氧合和呼吸力学，且不影响血流动力学稳定性。该策略支持个性化PEEP优化。
本试验在ClinicalTrials.gov上注册（注册号：ChiCTR2300070193，注册日期：2023年4月4日）。该试验为回顾性注册，因为在注册前已开始入组。
在线版本包含可在10.1186/s12871-025-03274-w获取的补充材料。
