Effect of ultrasound-guided individualized Positive end-expiratory pressure on the severity of postoperative atelectasis in elderly patients: a randomized controlled study

Abstract Background The mortality rate of postoperative pulmonary complications (PPCs) in general anesthesia patients can reach up to 20%. Our research hypothesis is that ultrasound-guided individualized PEEP titration can reduce the risk of PPCs. Methods This single-center randomized controlled trial. Eighty-nine patients scheduled for elective laparoscopic radical surgery for colorectal cancer were enrolled in our study. Patients were randomly assigned to two group: the study group (individualized PEEP groups, PEEP Ind group) and the control group (Fixed PEEP group, PEEP 5 group). All patients in these two groups received volume-controlled ventilation during general anesthesia. Patients in the study group were given ultrasound-guided PEEP, while those in the control group were given a fixed 5 cmH₂O PEEP. Bedside ultrasound assessed lung ventilation. The primary outcome was PPC incidence within seven days post-surgery. Results Lung ultrasound scores (LUSs) in the study group during postoperative seven days was significantly decreased compared with that in the control group (P < 0.05). The severity of postoperative atelectasis in the study group was significantly improved. The incidence of PPCs during postoperative seven days in the study group was significantly less than that in the control group (48.6% vs. 77.8%; RR = 0.625; CI = 0.430–0.909; P = 0.01). Conclusions Non-obese elderly patients undergoing laparoscopic radical resection by lung ultrasound-guided individualized PEEP can alleviate the severity of postoperative atelectasis.