Effect Of Driving Pressure Guided Peep Titration On Lung Injury And Postoperative Pulmonary Complications In Elderly Patients Undergoing Robot-assisted Radical Prostatectomy

Objective:To explore the impact of driving pressure（ΔP）titration of PEEP on lung injury and postoperative pulmonary complications（PPCs）in elderly patients undergoing robot-assisted radical prostatectomy（RARP）.Methods:46 patients selected for elective RARP and the ARISCAT was assessed as medium to high risk.They were divided into control group（Group C）andΔP titration group（Group D）（n=23）using a random number table method.Volume controlled mechanical ventilation was used after anesthesia induction and tracheal intubation.Group C used 5cm H2O fixed PEEP during operation;The patients in group D were treated immediately after mechanical ventilation and after the changes of body position and pneumoperitoneum pressure during operationΔP guide PEEP setting operation.The second titration increased according to the above method based on the optimal PEEP of the first titration.Monitor the patient’s vital signs,analyze arterial blood gas,and measure the secreted protein（CC16）of pulmonary Clara cells（CC16）and alveolar surfactant-Serum concentration of D（SP-D）,soluble receptor for advanced glycation end products（s RAGE）and soluble intercellular adhesion molecule（s ICAM-1）.All these steps were conducted in both group C and group D:In group C,4 min after mechanical ventilation with fixed PEEP（T₁）,2 h after establishment of Trendelenburg position（T₂）,1 min after extubation（T₃）and 2 h after operation respectively（T₄）;In group D,4 min after the completion of the first PEEP titration（T₁）,2 h after establishing Trendelenburg position（T₂）,1min after extubation（T₃）and 2 h after operation（T₄）.Assess the occurrence of pulmonary complications（PPCs）within 7 days after operation.Results:Compared with T₁,CC16,SP-D,s RAGE and s ICAM-1 at T_2-4 significantly increased（P<0.05）.Compared with group C,CC16,SP-D,s RAGE and s ICAM-1 at T_2-4 decreased in group D（P<0.05）.There was no significant difference in PPCs within 7days after operation（P>0.05）.Conclusion:The optimal PEEP byΔP titration can reduce lung tissue damage in elderly patients undergoing RARP,and has no significant effect on the occurrence of PPCs.