Effect of Individualized PEEP Guided by Driving Pressure on Diaphragm Function in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer: A Randomized Controlled Trial

Background:The concept of driving pressure (DP) has been established to optimize mechanical ventilation-induced lung injury.However, little is known about the specific effects of setting individualized positive end-expiratory pressure (PEEP) with driving pressure guidance on patient diaphragm function. Material/Methods:Ninety patients were randomized into 3 groups, with PEEP set to 0 in group C; 5 cmH 2 O in group F; and individualized PEEP in group I, based on esophageal manometry.Diaphragm ultrasound was performed in the supine position at 6 consecutive time points from T0-T5: diaphragm excursion, end-expiratory diaphragm thickness (Tdi-ee), and diaphragm thickening fraction (DTF) were measured.Primary indicators included diaphragm excursion, Tdi-ee, and DTF at T0-T5, and the correlation between postoperative DTF and DP.Secondary indicators included respiratory mechanics, hemodynamic changes at intraoperative d0-d4 time points, and postoperative clinical pulmonary infection scores. Results:(1) Diaphragm function parameters reached the lowest point at T1 in all groups (P<0.001).( 2) Compared with group C, diaphragm excursion decreased, Tdi-ee increased, and DTF was lower in groups I and F at T1-T5, with significant differences (P<0.05),but the differences between groups I and F were not significant (P>0.05).(3) DTF was significantly and positively correlated with mean intraoperative DP in each group at T3, and the correlation was stronger at higher levels of DP. Conclusions:Individualized PEEP, achieved by esophageal manometry, minimizes diaphragmatic injury caused by mechanical ventilation based on lung protection, but its protection of the diaphragm during laparoscopic surgery is not superior to that of conventional ventilation strategies.