Effect of electrical impedance tomography-guided positive end-expiratory pressure optimisation on postoperative pulmonary complications in laparoscopic colorectal surgery: a randomised controlled trial.

IF 10.3 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2026-10-20 DOI:10.1016/j.bja.2026.09.016

Tai-Hang Wang, Heng-Chang Liu, Wei Tang, Hui-Xian Li, Yu-Lin Sun, Fei Wang, Qing Zhao, Zhao-Xu Zheng, Hui Zheng, Tao Yan

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引用次数: 0

Abstract

Background: Pneumoperitoneum and steep Trendelenburg positioning during laparoscopic colorectal surgery promote atelectasis and increase the risk of postoperative pulmonary complications (PPCs). Electrical impedance tomography (EIT) enables individualised PEEP titration by visualising regional lung collapse, facilitating lung-protective ventilation. However, evidence of its effect on clinical PPCs remains limited.

Methods: In this single-centre, parallel-group RCT, adults with intermediate to high risk for PPCs (ARISCAT score ≥26) who underwent laparoscopic colorectal surgery were randomly assigned to receive intraoperative PEEP titration guided by EIT or a conventional fixed PEEP of 5 cm H₂O. The primary outcome was PPCs incidence within 30 days, as determined by a multidisciplinary adjudication team using standardised criteria.

Results: Among the 117 randomised participants (mean [range] age: 62 [37-80] yr; 37% female), EIT-guided PEEP (n=59) resulted in lower driving pressure (16 [15-18] cm H₂O) compared with fixed PEEP (n=58; 19 [17-22] cm H₂O; P<0.0001). The incidence of 30 day PPCs was lower among participants randomised to EIT-guided PEEP (29/59 [49.2%]) than those in the fixed-PEEP group (42/58 [72.4%]; hazard ratio: 0.53; 95% CI, 0.33-0.85; P=0.009). PPCs including atelectasis and pneumonia occurred less frequently among participants randomised to EIT-guided PEEP.

Conclusions: Compared with conventional fixed PEEP of 5 cm H₂O, EIT-guided PEEP was associated with a lower incidence of PPCs among patients at intermediate to high PPCs risk undergoing laparoscopic colorectal surgery, suggesting a role for EIT in intraoperative lung protection.

Clinical trial registration: Chinese Clinical Trial Registry, ChiCTR2300076677.

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电阻抗断层扫描引导下呼气末正压优化对腹腔镜结直肠手术术后肺部并发症的影响：一项随机对照试验。

背景：腹腔镜结直肠手术时气腹和陡的Trendelenburg定位会促进肺不张，增加术后肺部并发症（PPCs）的风险。电阻抗断层扫描（EIT）通过观察局部肺萎陷，促进肺保护性通气，实现个性化PEEP滴定。然而，它对临床PPCs的影响证据仍然有限。方法：在这项单中心、平行组的随机对照试验中，接受腹腔镜结直肠手术的PPCs中至高危（ARISCAT评分≥26）的成年人随机分为两组，一组接受EIT引导的术中PEEP滴定，另一组接受5 cm H2O的常规固定PEEP。主要结果是30天内PPCs的发病率，由多学科评审小组使用标准化标准确定。结果：117名随机受试者（平均[范围]年龄：62[37-80]岁；37%为女性）中，eit引导的PEEP （n=59）比固定PEEP (n=58; 19 [17-22] cm H2O；结论：与常规5 cm H2O固定PEEP相比，EIT引导下的PEEP在腹腔镜结直肠手术中高PPCs风险患者中PPCs发生率较低，提示EIT在术中肺保护中具有一定的作用。临床试验注册：中国临床试验注册中心，ChiCTR2300076677。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.