Comparison of Driving pressure guided ventilation versus conventional ventilation on postoperative lung atelectasis in patients undergoing Living donor liver transplant (LDLT)- A single centre randomised controlled trial

This single-centre randomized controlled trial evaluates whether driving pressure-guided ventilation offers better postoperative pulmonary outcomes than conventional lung-protective ventilation in adult patients undergoing living donor liver transplantation. The liver transplant patients often experience unique respiratory challenges, including decreased lung compliance due to factors like ascites and hepatopulmonary syndrome. These patients are at an increased risk for postoperative pulmonary complications (PPCs), making optimal ventilatory management a clinical priority.

Research shows that driving pressure, a measurement reflecting the pressure used to deliver each breath, is a stronger predictor of PPCs than conventional ventilator parameters. Although numerous studies in non-transplant surgical populations support limiting driving pressure to reduce the risk of PPCs, no randomized trials have specifically addressed this strategy in the context of liver transplantation. Unique characteristics of liver transplant recipients, such as altered physiology, dynamic intraoperative changes, and specific concerns around hemodynamic stability, make it necessary to validate these findings within the transplant cohort.

The proposed study fills this gap by directly comparing the incidence of lung atelectasis (as measured by lung ultrasound), oxygenation indices, pulmonary complications, respiratory and hemodynamic parameters, ventilator duration, ICU stay length, and early graft outcomes between the two ventilatory strategies.