Effects of Individualized PEEP Guided by Driving Pressure on Postoperative Atelectasis in Patients With Morbid Obesity

Yongtao Sun

Status: Enrolling

Conditions: Pulmonary Atelectasis; Obesity, Morbid

Treatments: Procedure: Individualized PEEP group; Procedure: Fixed PEEP group

Study type: Interventional

Funder types: Other

Identifiers

NCT06181279

DP guided PEEP

Details and patient eligibility

About

Atelectasis is a common complication in patients undergoing surgery under general anesthesia, particularly in obese patients. Postoperative atelectasis could last for more than 24h and contribute to a variety of other complications, including hypoxemia and pneumonia. We plan to conduct a single-center, randomized controlled trial in patients undergoing bariatric surgery to test the hypothesis that driving pressure guided PEEP could reduce the postoperative atelectasis.

Full description

Positive end-expiratory pressure (PEEP) is a strategy that helps to keep alveoli open during surgery and to prevent postoperative atelectasis. A fixed PEEP without considering the respiratory mechanics in individual patients, however, is not optimal. Individualized PEEP therefore has been increasingly studied, and has been shown to improve oxygenation in both nonobese and obese patients. Studies have shown that the occurrence and prognosis of PPCs are significantly associated with high driving pressure (DP), but not with VT and PEEP. Driving pressure-guided individualized PEEP is expected to be a novel perioperative lung protection strategy. Consequently, the main aim of this study is to investigate the effect of a driving pressure-guided individualized PEEP ventilation strategy on postoperative pulmonary atelectasis in morbidly obese patients undergoing bariatric surgery.

Enrollment: 52 estimated patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 to 60 years old;
• Body mass index (BMI) ≥ 40 kg/m2;
• ASA classification I to III;
• Signing the informed consent form for this clinical study;

Exclusion criteria

• Respiratory infection within 4 weeks; severe respiratory system diseases; history of pulmonary and/or thoracic surgery; neuromuscular dysfunction;
• Serious cardiac, renal or haematopoietic diseases;
• Contraindications to PEEP；

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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52 participants in 2 patient groups

Individualized PEEP group

Experimental group

Description:

After recruitment maneuver, PEEP is titrated decreasingly using driving pressure guided individualised PEEP ventilation strategy, and the PEEP corresponding to the lowest driving pressure is the individualised PEEP.

Treatment:

Procedure: Individualized PEEP group

Fixed PEEP group

Other group

Description:

After recruitment maneuver, PEEP is fixed at 8cmH2O.

Treatment:

Procedure: Fixed PEEP group