Effect Of Drive Pressure-guided PEEP Titration On Lung Function And Inflammatory Factors In Elderly Patients With Robot-assisted Radical Prostatectomy

Objective:Observe the effect of driving pressure（DP）-guided PEEP titration on lung function and inflammatory factors in elderly patients with robot-assisted radical prostatectomy（Robotics assisted laparoscopic radical prostatectomy,RARP）.Methods:Forty elderly patients with elective elective RARP surgery from September 2 0 2 0 to September 2 0 2 1 were selected,and the patients were randomly divided into two groups（n=20）:control group（Group C）and driving pressure guidance group（Group D）.In group D,two DP-guided PEEP titrations were performed after endotracheal intubation and after the establishment of postural pneumoperitoneum.Group C used fixed PEEP with5cm H₂O.After the optimal PEEP setting（after group C has fixed PEEP ventilation）4minutes（T₁）,optimal PEEP ventilation after titration in the pneumoperitoneum position（group C versus after pneumoperitoneum position change）was 1 hour（T₂）,2 hours（T₃）,1minute（T₄）after extubation,after surgery,at 2 hours（T₅）,results of the blood gas analysis were recorded.The concentrations of T₁,T₃,T₄,and T₅serum inflammatory factors[interleukin-6（IL-6）,interleukin-8（IL-8）,and tumor necrosis factor-α（TNF-α）]were detected and recorded.Recorded the airway peak pressure(P_peak),airway plateau pressure(P_plat),and of respiratory system dynamic compliance（Cdyn）at T₁,T₂and T₃time points.DP,oxygenation index（OI）,dead chamber/tidal volume ratio（V_D/V_T）,oxygen partial pressure difference in alveolar artery（A-a DO₂）,and respiratory index（RI）were also calculated.The incidence of postoperative pulmonary complications（PPCs）was recorded.Results:Compared with Group C,at different time points,Pa O₂,OI,and Cdyn were significantly increased（P<0.05）,the A-a DO₂and RI were reduced（P<0.05）,Serum inflammatory factors（IL-6,IL-8,TNF-α）were decreased.There was no significant difference in intraoperative P_peak,P_plat,Pa CO₂,and V_D/V_T（P>0.05）.No PPCs occurred in either group.Conclusion:Minimum drive pressure guided optimal PEEP setting could improve intraoperative lung function,improve patient oxygenation and reduce the inflammatory factor release,in elderly patients with RARP,but no positive effect on PPCs was found.