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

摘要

Background and objectivesWith 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.MethodsFifty-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.ResultsThe 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 CPATthan Group B at T3, T4, T5(p?