Effect of driving pressure-guided individualized PEEP in children undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass on postoperative atelectasis and oxygenation: a randomized controlled trial

BACKGROUND: Right lateral thoracotomy cardiac surgery induces postoperative atelectasis due to cardiopulmonary bypass (CPB), patient positioning, and mechanical ventilation. Fixed positive end-expiratory pressure (PEEP) may fail to meet pediatric ventilation requirements. This study aims to investigate the effects of driving pressure-guided individualised PEEP on postoperative atelectasis and oxygenation. METHODS: ), dynamic pulmonary compliance (Cdyn), PEEP, driving pressure, extubation time, length of ICU stay, length of hospital stay, heart rate and mean arterial pressure. RESULTS: (P < 0.05). The incidence of post-CPB hypoxemia and extubation time were lower in Group D (P < 0.05). Group D showed superior intraoperative respiratory mechanics parameters. However, there were no significant differences in the incidence of PPCs within 3 days, intraoperative hemodynamics, ICU length of stay, or hospital length of stay between the two groups (P > 0.05). CONCLUSIONS: Driving pressure-guided individualized PEEP ventilation reduces the incidence of postoperative atelectasis in children undergoing right lateral thoracotomy cardiac surgery with CPB. It also improves oxygenation and intraoperative respiratory mechanics. However, there was no significant difference in the incidence of PPCs within 3 days. TRIAL REGISTRATION: ChiCTR, ChiCTR2500098036. Registered on February 28, 2025, www.chictr.org.cn.