Intraoperative Driving Pressure-Guided High PEEP vs Standard Low PEEP for Postoperative Pulmonary Complications.

Background

To compare driving pressure-guided high PEEP and recruitment maneuvers with standard low PEEP without recruitment maneuvers with respect to postoperative pulmonary complications.

比较以驱动压为导向的高PEEP和肺复张手法与标准低PEEP（不包括肺复张手法）在术后肺部并发症方面的差异。

DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of 1435 adults at increased risk for postoperative pulmonary complications who were scheduled for open abdominal surgery.

设计、环境和参与者：一项涉及1435名有术后肺部并发症高风险的成人的随机临床试验，这些患者被安排进行开放性腹部手术。

The trial was conducted at 29 sites in 5 countries across Europe from April 2019 to December 2024; final follow-up was in March 2025.

该试验在2019年4月至2024年12月期间于欧洲5个国家的29个地点进行；最终随访在2025年3月完成。

Statistical analysis was conducted in May 2025.

统计分析于2025年5月进行。

intervention

Patients were randomized to undergo intraoperative ventilation with driving pressure-guided high PEEP and recruitment maneuvers (n = 718) or to intraoperative ventilation with standard low PEEP (n = 717).

患者被随机分配接受术中通气，一组使用驱动压力指导的高PEEP和肺复张操作（n = 718），另一组接受标准低PEEP的术中通气（n = 717）。

All patients received low tidal volume ventilation.

所有患者接受了低潮气量通气。

main_outcomes_and_measures

The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including severe respiratory failure, bronchospasm, suspected pulmonary infection, pulmonary infiltrates, aspiration pneumonitis, atelectasis, acute respiratory distress syndrome, pleural effusion, cardiopulmonary edema, and pneumothorax.

主要结果是在术后前5天内出现的肺部并发症的综合，包括严重呼吸衰竭、支气管痉挛、疑似肺部感染、肺浸润、吸入性肺炎、肺不张、急性呼吸窘迫综合征、胸腔积液、心肺水肿和气胸。

Among the 16 prespecified secondary outcomes, 4 concerned intraoperative complications, including hypotension (decrease in mean arterial pressure of >20% for >3 minutes) and desaturation (Spo2 <92% for >1 minute).

在16个预先设定的次要结果中，有4个涉及术中并发症，包括低血压（平均动脉压下降>20%持续>3分钟）和低氧饱和度（Spo2 <92%持续>1分钟）。

Results

Among 1468 adults, 1435 (98%) completed the trial (median [IQR] age, 66 [57-74] years; 52% female).

在1468名成年人中，有1435人（98%）完成了试验（中位年龄[四分位数间距]为66[57-74]岁；女性占52%）。

In the primary analysis population, the primary outcome occurred in 142 of 718 patients (19.8%) in the driving pressure-guided high PEEP group compared with 125 of 717 patients (17.4%) in the low PEEP group (absolute difference, 2.5% [95% CI, -1.5% to 6.4%]; P = .23).

在主要分析人群中，主要结果在驱动压力指导下的高PEEP组的718名患者中有142例（19.8%）发生，而在低PEEP组的717名患者中有125例（17.4%）发生（绝对差异，2.5% [95% 置信区间, -1.5% 至 6.4%]; P = .23）。

The incidenceof hypotension (382 [54.0%] vs 317 [45.0%]) and use of vasoactive agents (224 [32.0%] vs 130 [18.8%]) was higher in the high PEEP group; the incidenceof intraoperative desaturation (6 [0.8%] vs 20 [2.8%]) was higher in the low PEEP group.

高PEEP组的低血压发生率（382 [54.0%] vs 317 [45.0%]）和血管活性药物的使用率（224 [32.0%] vs 130 [18.8%]）更高；低PEEP组的术中低氧血症发生率（6 [0.8%] vs 20 [2.8%]）更高。

conclusions_and_relevance

Among patients at increased risk for postoperative pulmonary complications undergoing open abdominal surgery under general anesthesia, intraoperative ventilation with driving pressure-guided high PEEP and recruitment maneuvers, compared with a strategy with standard low PEEP, did not reduce postoperative pulmonary complications.

在全身麻醉下接受开放式腹部手术且术后肺部并发症风险增加的患者中，与标准低PEEP策略相比，术中使用驱动压力引导的高PEEP和肺复张手法，并未减少术后肺部并发症。

trial_registration

ClinicalTrials.gov Identifier: NCT03884543.

ClinicalTrials.gov 注册号：NCT03884543。