Effect of individualized positive end-expiratory pressure titration guided by electrical impedance tomography on oxygenation in patients undergoing laparoscopic surgery in the lateral decubitus position: a randomized controlled study
10.4097/kja.25704
- Author:
Yoon Jung KIM
;
Hyeonhoon LEE
;
Hyun-Kyu YOON
;
Hee-Soo KIM
- Publication Type:Clinical Research Article
- From:Korean Journal of Anesthesiology
2026;79(2):201-212
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Laparoscopic surgery in the lateral decubitus position can alter pulmonary mechanics and oxygenation. Although positive end-expiratory pressure (PEEP) may alleviate these effects, the optimal level remains unclear. This study evaluated whether electrical impedance tomography (EIT)–guided PEEP titration improves oxygenation compared to a fixed PEEP of 5 cmH2O.
Methods:In this randomized controlled trial, 74 adult patients undergoing robot-assisted or laparoscopic urologic surgery in the lateral decubitus position were assigned to either the EIT-guided or standard care group. The EIT-guided group underwent decremental PEEP titration to determine and maintain optimal PEEP throughout surgery. The standard care group received a fixed PEEP of 5 cmH2O. The primary outcome was ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) at the end of surgery. Secondary outcomes included intraoperative respiratory mechanics and postoperative pulmonary complications (PPCs) until discharge.
Results:Seventy-one patients completed the study (EIT-guided: 35, standard care: 36). The PaO2/FiO2 ratio at the end of surgery was higher in the EIT-guided group than in the standard care group (523.8 ± 82.4 vs. 414.6 ± 96.7 mmHg, P < 0.001). Driving pressure was lower in the EIT-guided group at 30 min after pneumoperitoneum initiation (15.8 [12.5, 17.4] vs. 19.9 [17.2, 22.5] cmH2O, P < 0.001) and at the end of surgery (9.1 [8.0, 10.4] vs. 10.0 [8.8, 12.6] cmH2O, P = 0.033). PPCs did not differ between groups.
Conclusions:EIT-guided PEEP titration improved intraoperative oxygenation. Further studies are needed to assess clinical outcomes.
