Individualized positive end-expiratory pressure in patients undergoing thoracoscopic lobectomy: a randomized controlled trial

Background and objectives: With the intensive study of lung protective ventilation strategies, people begin to advocate the individualized application of positive end-expiratory pressure (PEEP). This study investigated the optimal PEEP in patients during one-lung ventilation (OLV) and its effects on pulmonary mechanics and oxygenation. Methods: Fifty-eight patients who underwent elective thoracoscopic lobectomy were randomly divided into two groups. Both groups received an alveolar recruitment maneuver (ARM) after OLV. Patients in Group A received optimal PEEP followed by PEEP decremental titration, while Group B received standard 5 cmH2O PEEP until the end of OLV. Relevant indexes of respiratory mechanics, pulmonary oxygenation and hemodynamics were recorded after entering the operating room (T0), 10 minutes after intubation (T1), pre-ARM (T2), 20 minutes after the application of optimal PEEP (T3), at the end of OLV (T4) and at the end of surgery (T5). Postoperative outcomes were also assessed. Results: The optimal PEEP obtained in Group A was 8.8 +/- 2.4 cmH2O, which positively correlated with BMI and forced vital capacity (FVC). Group A had a higher CPAT than Group B at T3, T4, T5 (p < 0.05) and a smaller AP than Group B at T3, T4 (p < 0.01). At T4, PaO2 was significantly higher in Group A (p < 0.01). At T3, stroke volume variation was higher in Group A (p < 0.01). Postoperative outcomes did not differ between the two groups. Conclusions: Our findings suggest that the individualized PEEP can increase lung compliance, reduce driving pressure, and improve pulmonary oxygenation in patients undergoing thoracoscopic lobectomy, with little effect on hemodynamics. (c) 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).