Effect of dynamic lung compliance-guided positive end-expiratory pressure on postoperative pulmonary complications following thoracoscopic lobectomy: a randomized controlled trial

The risk of postoperative pulmonary complications is significantly increased in patients undergoing video-assisted thoracic surgical lobectomy. Individualized positive end-expiratory pressure (PEEP) is extensively employed to optimize respiratory mechanics and enhance oxygenation during one-lung ventilation (OLV). However, there is no consensus regarding the optimal level of positive end-expiratory pressure and its effects during OLV. Therefore, we designed a randomized controlled trial to assess whether titrating PEEP to the maximum dynamic lung compliance in patients undergoing lung resection surgery impacts the occurrence of postoperative pulmonary complications (PPCs). In this randomized controlled trial, patients undergoing thoracoscopic lobectomy were randomly assigned to either a dynamic lung compliance group that received individualized PEEP guided by the maximum dynamic pulmonary compliance or a conventional ventilation group with a fixed PEEP of 5 cm H2O. The primary outcome was a composite of PPCs occurring within seven days, as defined by the European Perioperative Clinical Outcome criteria. Secondary outcomes included PEEP, Cdyn, PaO2, serum concentrations of IL-6 and TNF-α, and the duration of postoperative hospital stays. One hundred patients were enrolled. The optimal PEEP obtained in the dynamic lung compliance group was 9.04 ± 1.83 cm H2O. Patients in the conventional ventilation group experienced 38% postoperative pulmonary complications versus 20% in the dynamic lung compliance group compared with the control group (P < 0.01). The serum Interleukin-10 concentrations at T5 in the dynamic lung compliance group were higher than those in the ventilation group (P = 0.046), and the serum Interleukin-1 concentrations at T5 and T6 in the dynamic lung compliance group were lower than those in the ventilation group (P < 0.01). In patients undergoing video-assisted thoracoscopic lobectomy for lung resection with maximum dynamic compliance-guided positive end-expiratory pressure (PEEP), the incidence of postoperative pulmonary complications (PPCs) within 7 days was significantly lower compared to those receiving a PEEP of 5 cm H2O. This study was registered at the Chinese Clinical Trials Registry on 04/07/2021 with registration number ChiCTR2100048201.