Effect of Individualized PEEP on Perioperative Pulmonary Complications in Elderly Patients with Prostate Cancer Undergoing General Anesthesia in Trendelenburg Position: A Single-Center Retrospective Study

ABSTRACT

Objective: This study aimed to explore the effect of individualized positive end-expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in elderly patients with prostate cancer undergoing general anesthesia in Trendelenburg position (low-head and high-foot position at about 45° when patients were in supine position). Methods: The clinical data of 96 elderly patients undergoing Leonardo’s robotic-assisted laparoscopic radical prostatectomy in Zhejiang Provincial People’s Hospital from October 2021, to April 2023, were selected for retrospective analysis. Sixteen patients who had interrupted follow-up or did not meet the inclusion criteria were excluded, and 80 patients were finally included. The patients were divided into group A (lung-protective strategy using routine PEEP value, n = 40) and group B (lung-protective strategy using individualized PEEP value, n = 40) on the basis of different inversion methods. The PEEP value of group A was set as 5 cmH2O, whereas that of group B was determined under the guidance of static lung compliance. The incidences of PPCs on postoperative day 7 were statistically analyzed, and the serum levels of interleukin (IL) 6 (IL-6) and IL-8 in both groups were measured by enzyme-linked immunoadsordent assay (ELISA). Results: The incidence of pulmonary complications was obviously lower in group B than in group A on postoperative day 7 (p < 0.001). Group B had lower levels of serum IL-6 and IL-8 at the end of surgery (T1) and 12 h after surgery (T2, p < 0.001); Higher oxygenation index values 10 min after successful titration of individualized PEEP (A3), 1 h after individualized PEEP ventilation (A4), 2 h after individualized PEEP ventilation (A5), 10 min after recovery of supine position (A6), and 30 min after tracheal extubation (A7); And lower hospitalization time (all p < 0.001) than group A (AU)