Effect of driving pressure-guided PEEP titration on lung injury in elderly patients undergoing robot-assisted radical prostatectomy
10.3760/cma.j.cn131073.20211118.00108
- VernacularTitle:驱动压指导PEEP滴定对机器人辅助前列腺癌根治术老年患者肺损伤的影响
- Author:
Jiayu ZHU
1
;
Jing YAO
;
Zixuan WANG
;
Chao LI
;
Xin YUAN
;
Xin WANG
;
Xuesen SU
;
Wenjie ZHANG
;
Lixia NIE
;
Shouyuan TIAN
Author Information
1. 山西医科大学麻醉学院，太原 030000
- Keywords:
Positive-pressure respiration;
Robotic surgical procedures;
Prostatic neoplasms;
Aged;
Lung injury
- From:
Chinese Journal of Anesthesiology
2022;42(1):39-43
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of driving pressure (ΔP)-guided PEEP titration on lung injury in elderly patients undergoing robot-assisted radical prostatectomy (RARP).Methods:Forty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-28 kg/m 2, with Assess Respiratory Risk in Surgical Patients in Catalonia score assessed as medium to high risk, scheduled for elective RARP, were divided into control group (group C, n=23) and ΔP titration group (group D, n=23) using a random number table method.Volume-controlled mechanical ventilation was used after anesthesia induction and tracheal intubation.In group C, 5 cmH 2O was used to fix PEEP.In group D, the optimal PEEP was titrated after computer-controlled breathing and after establishing Trendelenburg position and pneumoperitoneum, the first titration started from 4 cmH 2O and increased by 1 cmH 2O every 4 min until ΔP reached the minimum value or PEEP increased to 12 cmH 2O, and the second titration was increased in increments as the method described above based on the optimal PEEP of the first titration.At 4 min after completion of the first PEEP titration (T 1, 4 min after mechanical ventilation with fixed PEEP in group C), 2 h after establishment of Trendelenburg position (T 2), 1 min after extubation (T 3) and 2 h after operation (T 4), serum concentrations of Clara cell protein (CC16), surfactant protein D (SP-D), soluble receptor for advanced glycation end-products (sRAGE) and soluble intercellular adhesion molecule-1 (sICAM-1). Pulmonary complications were assessed within 7 days after operation. Results:The serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly higher at T 2-4 than at T 1 in two groups ( P<0.05). Compared with group C, the serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly decreased at T 2-4 ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after operation in group D ( P>0.05). Conclusions:ΔP-guided PEEP titration can reduce lung injury in elderly patients undergoing RARP.
