Driving Pressure-Guided Ventilation in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

Abstract

Purpose This study aims to compare the conventional lung protective ventilation strategy (LPVS) with driving pressure-guided ventilation in obese patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods Forty-five patients undergoing elective LSG under general anesthesia were randomly assigned to the conventional LPVS group (group L) or the driving pressure-guided ventilation group (group D) using random numbers generated by Excel. The primary outcome was the driving pressure of both groups 90 min after pneumoperitoneum. Results After 30 min of pneumoperitoneum, 90 min of pneumoperitoneum, 10 min of closing the pneumoperitoneum, and restoring the supine position, the driving pressure of group L and group D were 20.0 ± 2.9 cm H 2 O vs 16.6 ± 3.0 cm H 2 O ( P < 0.001), 20.7 ± 3.2 cm H 2 O vs 17.3 ± 2.8 cm H 2 O ( P < 0.001), and 16.3 ± 3.1 cm H 2 O vs 13.3 ± 2.5 cm H 2 O ( P = 0.001), respectively; the respiratory compliance of groups L and D were 23.4 ± 3.7 mL/cm H 2 O vs 27.6 ± 5.1 mL/cm H 2 O ( P = 0.003), 22.7 ± 3.8 mL/cm H 2 O vs 26.4 ± 3.5 mL/cm H 2 O ( P = 0.005), and 29.6 ± 6.8 mL/cm H 2 O vs 34.7 ± 5.3 mL/cm H 2 O ( P = 0.007), respectively. The intraoperative PEEP in groups L and group D was 5 (5–5) cm H 2 O vs 10 (9–11) cm H 2 O ( P < 0.001). Conclusion An individualized peep-based driving pressure-guided ventilation strategy can reduce intraoperative driving pressure and increase respiratory compliance in obese patients undergoing LSG.