Comparison of Incremental, Decremental, and Fixed PEEP Strategies on Mechanical Power and Postoperative Oxygenation in Robotic Surgery: A Prospective Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 120
- 主要终点
- Cumulative Mechanical Power (MP-AUC)
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age>= 18
- •ASA I-III
- •Elective robotic surgery
排除标准
- •COPD GOLD ≥2
- •Restrictive lung disease
- •BMI >40 kg/m²
- •Heart failure
- •Preoperative oxygen requirement
- •Need for postoperative mechanical ventilation
- •Refusal to participate
研究组 & 干预措施
Fixed PEEP
Ventilation with constant PEEP of 5 cmH₂O throughout surgery.
干预措施: Fixed PEEP Ventilation (Procedure)
Fixed PEEP
Ventilation with constant PEEP of 5 cmH₂O throughout surgery.
干预措施: Decremental PEEP Strategy (Procedure)
Fixed PEEP
Ventilation with constant PEEP of 5 cmH₂O throughout surgery.
干预措施: Incremental PEEP Strategy (Procedure)
Decremental PEEP
PEEP is gradually decreased to identify the level associated with the lowest driving pressure or lowest mechanical power.
干预措施: Fixed PEEP Ventilation (Procedure)
Decremental PEEP
PEEP is gradually decreased to identify the level associated with the lowest driving pressure or lowest mechanical power.
干预措施: Decremental PEEP Strategy (Procedure)
Decremental PEEP
PEEP is gradually decreased to identify the level associated with the lowest driving pressure or lowest mechanical power.
干预措施: Incremental PEEP Strategy (Procedure)
Incremental PEEP
PEEP is gradually increased to determine the optimal level corresponding to the lowest driving pressure or mechanical power.
干预措施: Fixed PEEP Ventilation (Procedure)
Incremental PEEP
PEEP is gradually increased to determine the optimal level corresponding to the lowest driving pressure or mechanical power.
干预措施: Decremental PEEP Strategy (Procedure)
Incremental PEEP
PEEP is gradually increased to determine the optimal level corresponding to the lowest driving pressure or mechanical power.
干预措施: Incremental PEEP Strategy (Procedure)
结局指标
主要结局
Cumulative Mechanical Power (MP-AUC)
时间窗: During surgery (from intubation to extubation)
Total energy delivered to the respiratory system during surgery
次要结局
- 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)
研究者
Betül Güven
Assos prof
Ankara City Hospital Bilkent