Impaired Oxygenation, Mechanical Ventilation, Postoperative Pulmonary Complications
Conditions
Brief summary
Robotic surgery requires pneumoperitoneum and steep Trendelenburg positioning, which significantly impair respiratory mechanics and increase the risk of postoperative pulmonary complications. Positive end-expiratory pressure (PEEP) is a key determinant of lung recruitment; however, fixed PEEP strategies may not be optimal for all patients. Individualized PEEP titration strategies, including incremental and decremental approaches, may better optimize lung mechanics. This randomized controlled trial aims to compare the effects of incremental, decremental, and fixed PEEP strategies on cumulative mechanical power (MP-AUC) and postoperative oxygenation in patients undergoing robotic surgery.
Interventions
PROCEDUREFixed PEEP Ventilation
Patients receive mechanical ventilation with a constant positive end-expiratory pressure (PEEP) of 5 cmH₂O throughout the surgical procedure.
PROCEDUREDecremental PEEP Strategy
PEEP is gradually decreased from a higher level to determine the optimal PEEP associated with the lowest driving pressure or lowest mechanical power, and this level is maintained during surgery.
PROCEDUREIncremental PEEP Strategy
PEEP is gradually increased from a lower level to identify the optimal PEEP corresponding to the lowest driving pressure or mechanical power, and this level is maintained during surgery.
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age\>= 18 * ASA I-III * Elective robotic surgery
Exclusion criteria
* COPD GOLD ≥2 * Restrictive lung disease * BMI \>40 kg/m² * Heart failure * Preoperative oxygen requirement * Need for postoperative mechanical ventilation * Refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative Mechanical Power (MP-AUC) | During surgery (from intubation to extubation) | Total energy delivered to the respiratory system during surgery |
Secondary
| Measure | Time frame |
|---|---|
| PaO₂/FiO₂ ratio | Intraoperative period and postoperative period (within 2 hours) |
| Oxygenation Index (OSI) | Postoperative 2 hours |
| Postoperative Pulmonary Complications (PPC) | Within 7 postoperative days |
Outcome results
None listed