Evaluation of the respiratory effects of driving pressure-targeted mechanical ventilation with electrical impedance tomography in patients undergoing robot-assisted laparoscopic radical prostatectomy

Aim: Due to factors such as the Trendelenburg position and pneumoperitoneum applied during robot-assisted laparoscopic radical prostatectomy (RALRP), postoperative pulmonary complications (PPC) may occur. The aim of our study is to evaluate the effects of personalized PEEP,based on driving pressure approach, versus fixed PEEP on lung gas distribution during RALRP using electrical impedance tomography (EIT),and to compare postoperative pulmonary complications (PPCs). Material And Method: Our study was conducted with 42 patients undergoing RALRP.Patients aged 18-80 years, with ASA score of 1-3, were included. In control group, fixed PEEP of 5 cmH₂O was applied."Personalized" PEEP value that provided lowest driving pressure as a result of PEEP titration was applied in study group. The GI index and ROI3 + ROI4 values, as well as PPC rates, were compared. Results: The patient characteristics, hemodynamics, and surgery-related variables were similar.The GI index, was 0.40±0.04 in the study group and 0.44±0.04 in the control group before extubation; post-extubation values were 0.38±0.03 and 0.43±0.03,respectively (p<0.05).Ventilation was more homogeneous in study group. The ROI3+ROI4 values, representing dorsal ventilation, were observed to increase in the study group compared to the control group before extubation (study group: 40.30±13.16, control group: 31.95±9.10)(p<0.05). Our study demonstrated that personalized PEEP reduced PPCs (PPC rate was 26.1% in the personalized group and 63.2% in the fixed group; p=0.016). Conclusion: In patients undergoing RALRP, personalized PEEP provides more homogeneous lung ventilation compared to fixed PEEP, as demonstrated by the GI index calculated through EIT. It was found that personalized PEEP application reduced PPCs.