Comparison of Individualised PEEP Using Lung Compliance versus Body Mass Index in Laproscopic Gynaecological surgery: A Randomized Controlled Trial

This randomized controlled trial will compare individualized positive end-expiratory pressure (PEEP) titrated using lung compliance with BMI-based PEEP during elective laparoscopic gynaecological surgery under general anaesthesia. Laparoscopic procedures with pneumoperitoneum and Trendelenburg positioning impair respiratory mechanics and may increase driving pressure atelectasis, and postoperative pulmonary complications. There is currently no consensus on the optimal method to select intraoperative PEEP.

A total of 60 adult female patients will be randomized into two groups. Group C will receive individualized PEEP identified by an incremental–decremental PEEP titration aimed at achieving the lowest driving pressure. Group B will receive BMI-based PEEP. Standardized anaesthesia, ventilation settings, and intraoperative monitoring will be used for all participants.

The primary outcome is mean intraoperative driving pressure. Secondary outcomes include respiratory compliance lung aeration measured by Lung Ultrasound Score oxygenation parameters  haemodynamic stability, and incidence of postoperative pulmonary complications. The study aims to determine whether compliance-guided individualized PEEP improves intraoperative respiratory mechanics and postoperative lung aeration compared to BMI-based PEEP