Effect of Positive end-Expiratory Pressure on Pulmonary Compliance and Pulmonary Complications in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy

Abstract

Purpose To observe the effects of different levels of positive end-expiratory pressure (PEEP) ventilation strategies on pulmonary compliance and complications in patients undergoing robotic-assisted laparoscopic prostate surgery. Methods A total of 120 patients with American Society of Anesthesiologists Physical Status Class I or II who underwent elective robotic-assisted laparoscopic prostatectomy were enrolled. The patients were randomly divided into three groups of 40 patients each: control (PEEP = 0 cmH2O), low-level (PEEP = 5 cmH2O), and high-level (PEEP = 10 cmH2O). Volume control ventilation with an intraoperative deep muscle relaxation strategy was used intraoperatively. Respiratory mechanics indexes were recorded at six time points: 10 min after anesthesia induction, immediately after pneumoperitoneum establishment, 30 min, 1 h, 1.5 h, and at the end of pneumoperitoneum (T1-T6). Arterial blood gas analysis and oxygenation index calculation were performed at T1, T4, and after tracheal extubation (T7). Postoperative pulmonary complications were also recorded. Results After pneumoperitoneum, peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean pressure (Pmean), driving pressure (ΔP), and airway resistance (Raw) increased significantly and pulmonary compliance (Crs) decreased, persisting during pneumoperitoneum in all groups. Between T2–T5, the low-level group had the highest Crs value and the lowestΔP (driving pressure) value relative to the high-level and control groups (P < 0.05). At T4 and T7, the PaCO2 and PaO2/FiO2 did not significantly differ among the three groups. There was no significant difference in postoperative pulmonary complications among the three groups. Conclusion High levels of intraoperative PEEP increased lung compliance without significantly reducing postoperative pulmonary complications.