Personalized positive end-expiratory pressure (PEEP) based on pulmonary compliance may improve intraoperative hemodynamics and postoperative outcomes in thoracic surgery. This study aimed to evaluate the effect of individualized, compliance-guided PEEP titration on cardiac output (CO) and postoperative pulmonary complications (PPCs) in patients undergoing video-assisted thoracoscopic pulmonary resection. In this prospective randomized controlled trial, 80 patients scheduled for thoracoscopic pulmonary resection were allocated to either an individualized PEEP group (Group N) or a fixed PEEP group (Group C). Group N received dynamic PEEP titration starting at 15 cmH2O, adjusted to optimize compliance; Group C received a fixed PEEP of 5 cmH2O. Hemodynamic parameters including CO, heart rate (HR), and systemic vascular resistance (SVR) were recorded at five time points: baseline after admission (T1), 20 min after initiating two-lung ventilation (T2), 30 min following PEEP implementation (T10), 60 min post-PEEP adjustment (T11), and upon completion of one-lung ventilation (T12). PPCs and postoperative pneumonia incidence were also recorded. Seventy-six patients completed the study (n = 38 per group). At T11, T12, Group N showed significantly higher CO than Group C. The optimal PEEP range for compliance was 7–13 cmH2O. Compared to 5 cmH₂O PEEP of individualized PEEP during OLV resulted in better lung compliance, lower driving pressure, and higher mean airway pressure, without differences in peak airway pressure or PETCO2. Postoperative pulmonary complications (PPCs) occurred more frequently in Group C (42.1% vs. 13.2%, p = 0.004). No significant differences were observed in overall SVR trends between groups, except at T11, T12. Compliance-guided individualized PEEP improves cardiac output and may reduce postoperative pulmonary complications in patients undergoing thoracoscopic lung resection. This approach holds promise for enhancing perioperative respiratory and hemodynamic stability. Trial registration: ChiCTR2100048201, intervention study, registered on 04/07/2021.
Zhu et al. (2026) studied this question.