Effect Of Driving Pressure-guided Individua Lized Positive End-expiratory Pressure Titrat Ion On Pulmonary Ventilation Function And Postoperative Pulmonary Complications In Children Undergoing Laparoscopic Surgery

Objective:To investigate the influence of driving pressure-guided individualized positive end expiratory pressure（PEEP）titration on pulmonary ventilation function and postoperative pulmonary complications in children undergoing laparoscopic surgery.Methods:A total of 46 children who underwent laparoscopic surgery were included,ranging in age from 1 to 6 years,regardless of gender.After genera l anesthesia in all children,volume-controlled ventilation mode was selected,th e tidal volume of 8 ml/kg,basic PEEP value to 2cm H₂O.They were randomly divided into the driving pressure-guided individualized PEEP group（23 cases i n group D）and the fixed PEEP group（23 cases in group F）.Group D:The lowest driving pressure was obtained for every 1cm H₂O increase in PEEP,whi ch was repeated every 1h.Group F:PEEP of 5 cm H₂O was used throughout t he procedure.The plateau pressure（Pplat）,PEEP,driving pressure,lung dynami c compliance,mean arterial pressure and heart rate at 5 minutes after intubatio n（T₁）,5 minutes after pneumoperitoneum（T₂）,4 minutes after PEEP（T₃）and at the end of surgery（T₄）were recorded respectively.Lung ultrasound scores a t T₁,T₄,and T₅（out of PACU）were recorded;The occurrence of postoperativ e pulmonary complications within 7 days after surgery was recorded;Intraopera tive pneumoperitoneum time,pneumoperitoneum pressure,mechanical ventilation time and operation time.Results:Compared with T₁,the lung dynamic compliance of the two groups decreased at T₂（P<0.05）,and the driving pressure was significantly increased（P<0.05）.Compared with T₂,both groups could improve the driving pressure and lung dynamic compliance at T₃ and T₄（P<0.05）.Compared with group F,group D had more advantages in improving lung dynamic compliance and driving pressure,and reducing lung ultrasound score（P<0.05）at T₃ and T₄.Group D could reduce the incidence of postoperative pulmonary complications than group F（13%versus 39.1%,group D versus Group F,P<0.05,OR:0.33）.There was no statistically significant difference between the two groups on heart rate and mean arterial pressure.Conclusions:For children aged 1-6 years,ASAⅠ～Ⅱ,who underwent laparoscopic surgery,driving pressure-guided individualized PEEP can significantly improve lung dynamic compliance,reduce driving pressure and lung ultrasound score（LUS）,and can also reduce the incidence of pulmonary complications in children within 7 days of surgery.