Pediatric laparoscopic surgery often induces atelectasis due to pneumoperitoneum, postural changes, and immature respiratory physiology, increasing postoperative pulmonary complications (PPCs). Fixed PEEP may fail to address perioperative variability. This study evaluated whether dynamic PEEP adjustment reduces atelectasis and improves oxygenation. Children at moderate or high risk of PPCs undergoing elective laparoscopic surgery were randomized into two groups. Group A had driving pressure-guided individualized PEEP titration at three specified time points: after intubation, before pneumoperitoneum initiation, and after pneumoperitoneum completion. Group B had individualized PEEP titration only after intubation, with this PEEP maintained until the end of ventilation. Both groups received alveolar recruitment maneuvers (ARMs). Observations were conducted at 5 min after tracheal intubation (T1), 20 min post-pneumoperitoneum (T2), 60 min post-pneumoperitoneum (T3), at the end of surgery (T4), and at extubation (T5). The primary outcome were intraoperative lung ultrasound score. Secondary outcomes included incidence of atelectasis, oxygenation index, peak airway pressure, plateau pressure, PEEP, driving pressure, dynamic lung compliance, mean arterial pressure, and heart rate. At T4 and T5, Group A showed significantly lower subpleural consolidation scores, total lung ultrasound scores, and atelectasis rates versus Group B (P 0.05). Driving pressure-guided dynamic PEEP titration reduces postoperative lung ultrasound abnormalities and atelectasis while improving oxygenation and respiratory mechanics in pediatric laparoscopy, without compromising hemodynamic stability. This strategy supports personalized PEEP optimization. This trial was registered on Clinical Trials.gov (Registration No. ChiCTR2300070193, Registration date: 2023-04-04). The trial was retrospectively registered as enrollment began prior to registration. • Compared to static PEEP strategies, driving pressure-guided dynamic PEEP titration during pediatric laparoscopic surgery significantly reduces intraoperative atelectasis, improves oxygenation, and shortens postoperative extubation time. • Driving pressure-guided dynamic PEEP titration optimizes respiratory mechanics under pneumoperitoneum, offering a feasible non-invasive approach to personalized lung protection in children. • The driving pressure-guided dynamic PEEP titration demonstrated robust safety by maintaining hemodynamic stability while enhancing pulmonary compliance and minimizing ventilator-induced lung injury.
Guo et al. (Wed,) studied this question.