Individualized PEEP Improves Pulmonary Outcomes After Laparoscopic Hysterectomy: A Prospective Randomized Study

Abstract

Objective: Trendelenburg positioning and pneumoperitoneum during laparoscopic surgeries can impair pulmonary function and increase the risk of postoperative pulmonary complications (PPCs). This study aimed to investigate the effects of individualized positive end-expiratory pressure (PEEP) on respiratory parameters and PPCs compared to conventional PEEP strategies in patients undergoing laparoscopic total hysterectomy.Materials and Methods: In this prospective, randomized controlled trial, 113 patients with ASA physical status I–III were randomized into two groups: individualized PEEP group (PEEPᵢ, n=56) and fixed PEEP 5 cmH₂O group (PEEP₅, n=57). Optimal PEEP in the PEEPᵢ group was determined via a stepwise recruitment maneuver guided by dynamic compliance. The primary endpoint was the incidence of PPCs within the first 7 postoperative days. Secondary endpoints included oxygen requirement, CPAP or mechanical ventilation use, and length of hospital stay.Results: The mean optimal PEEP in the PEEPᵢ group was 14 cmH₂O (IQR: 10–14). The incidence of PPCs was significantly lower in the PEEPᵢ group compared to PEEP₅ (7.7% vs. 34.7%, p=0.001). Dynamic compliance was higher and driving pressure significantly lower in the PEEPᵢ group (p