Effect of Intraoperative Lung-Protective Ventilation on Postoperative Pulmonary Complications in Adult Patients Undergoing Elective Craniotomy: A Double-Blind Randomized Controlled Trial

BackgroundMechanical ventilation is essential during general anesthesia; however, conventional ventilation strategies may contribute to ventilator-induced lung injury and postoperative pulmonary complications (PPCs).Lungprotective ventilation (LPV), incorporating low tidal volumes and positive end-expiratory pressure (PEEP), may improve pulmonary outcomes.Its application during elective craniotomy remains controversial because of concerns regarding intracranial pressure and surgical brain relaxation.This study aimed to compare the effects of intraoperative lung-protective and conventional ventilation on PPCs in adult patients undergoing elective craniotomy. MethodsThis prospective, randomized, controlled trial included 160 adult patients with American Society of Anesthesiologists physical status I-II undergoing elective craniotomy under general anesthesia.Patients were randomly allocated to receive either LPV group (Group A; tidal volume 6 mL/kg predicted body weight (PBW) with PEEP of 6 cmH₂O) or conventional ventilation (CV) group (Group B; tidal volume 10 mL/kg PBW without PEEP).The primary outcome was the incidence of PPCs during the first seven postoperative days.Secondary outcomes included respiratory mechanics, arterial blood gas parameters, brain relaxation scores, hemodynamic variables, and duration of neurosurgical intensive care unit stay. ResultsBaseline demographic and perioperative characteristics were comparable between the groups.The incidence of PPCs was significantly lower in the LPV group than in the CV group (p < 0.001).LPV was associated with higher dynamic lung compliance, lower driving pressure, a lower respiratory index, and improved oxygenation.Although brain relaxation scores were slightly better in the CV group, moderate PEEP did not adversely affect surgical exposure or postoperative neurological outcomes.The duration of neurosurgical intensive care unit stay was significantly shorter in the LPV group.No ventilation-related adverse events, including barotrauma or pneumothorax, were reported. ConclusionIntraoperative LPV using low tidal volumes and moderate PEEP reduced PPCs and improved respiratory mechanics in adults undergoing elective craniotomy, without clinically significant impairment of surgical brain relaxation.These findings support its potential use in appropriately selected neurosurgical patients.