Regulatory role of permissive hypercapnia in inflammatory response and postoperative recovery: Evidence from laparoscopic surgery patients

Objective: As a lung-protective ventilation strategy, the regulatory effects of permissive hypercapnia on inflammatory mediators and clinical outcomes during laparoscopic surgery remain insufficiently clarified. This study investigated the impact of permissive hypercapnia on perioperative cytokine profiles and patient recovery in laparoscopic procedures. Methods: A retrospective analysis was conducted including 72 patients who received permissive hypercapnia ventilation (observation group) and 58 patients who underwent conventional ventilation (control group). Serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α), the oxygenation index (OI), and alveolar-arterial oxygen difference (P(A-a) O 2 ) were measured at multiple perioperative time points. Surgery-related indicators and postoperative complications were recorded. Results: At 24 h postoperatively, the observation group exhibited significantly lower IL-6 and TNF-α concentrations and higher IL-10 levels compared with the control group ( p < 0.05). At 30 min after pneumoperitoneum and 24 h postoperatively, both OI and P(A-a) O 2 were higher in the observation group, whereas at the end of surgery they were slightly lower than in the control group (all p < 0.05). Extubation time (17.49 ± 3.62 min), hospital stay (5.67 ± 1.24 days), and complication rate (12.50%) were significantly improved in the observation group versus controls ( p < 0.05). Conclusion: Permissive hypercapnia effectively modulates the balance of IL-6, IL-10, and TNF-α, enhances pulmonary oxygenation, attenuates perioperative inflammation, accelerates postoperative recovery, and reduces complications. These findings support its value as a lung-protective ventilation strategy in laparoscopic surgery.