Anaesthesiology intensive therapy最新文献

{"title":"Objective monitoring of acute pain and nociception in anaesthesia and intensive care: evidence and applications.","authors":"Justyna Karolina Danel, Jowita Rosada-Kurasinska, Maja Magdalena Copik, Szymon Zdanowski, Wojciech Gola, Hanna Misiołek, Alicja Bartkowska-Śniatkowska, Szymon Białka","doi":"10.5114/ait/213842","DOIUrl":"10.5114/ait/213842","url":null,"abstract":"<p><p>Assessing pain in non-communicative patients remains challenging in anaesthesia and intensive care. When self-report is unavailable, clinicians infer nociception from behaviour and physiology. Behavioural scales such as the Behavioral Pain Scale and the Critical-Care Pain Observation Tool are simple and reproducible, supporting consistent practice; however, performance declines with deep sedation, neuromuscular blockade, or severe neurological injury. Where behavioural cues are absent or unreliable, physiological and neurophysiological signals provide partial information. Autonomic indicators, including heart rate variability, the Surgical Pleth Index, pupillometry, and skin conductance, capture sympathetic responses to noxious stimuli rather than perceived pain and are sensitive to drugs, haemodynamic instability, shivering, and agitation. Electroencephalography and functional near-infrared spectroscopy identify cortical responses to nociceptive input, yet clinically useful thresholds remain context dependent, and most applications are research-based. Emerging machine-learning systems that integrate behaviour and physiology show promise, but models validated in the operating room are not automatically applicable in the intensive care unit and require new external validation with potential recalibration. Evidence is generally stronger intraoperatively than in intensive care, and paediatric data are limited. No instrument directly measures subjective pain when self-report is absent. Available tools index nociception through behavioural and physiological correlates and must be interpreted within the clinical context.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"365-380"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular effects of intra-abdominal hypertension: current perspectives.","authors":"Hatem Soliman Aboumarie, Prashant Nasa, Manu L N G Malbrain","doi":"10.5114/ait/210612","DOIUrl":"10.5114/ait/210612","url":null,"abstract":"<p><p>Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are now recognized as important but often underdiagnosed contributors to cardiovascular instability in critically ill patients. Recent studies have clarified the mechanisms by which elevated intra-abdominal pressure (IAP) reduces venous return, raises intrathoracic pressure, and impairs both preload and contractility while increasing afterload. These pathophysiological changes can compromise organ perfusion even at modest IAP elevations, and the interplay between cardiovascular, renal, and hepatic dysfunction has led to the concept of the cardio-abdomino-renal syndrome. Advances in monitoring have shifted practice away from static pressure indices such as central venous and pulmonary artery occlusion pressures. Emerging evidence supports the use of abdominal perfusion pressure, mean perfusion pressure, and volumetric indices obtained by transpulmonary thermodilution, alongside echocardiography and ultrasound-based venous congestion assessment. These tools enable individualized resuscitation strategies, balancing fluid therapy with the risks of exacerbating IAH. The purpose of this review is to synthesize recent evidence on the cardiovascular consequences of IAH and ACS, highlight evolving monitoring techniques, and outline current approaches to management. By integrating updated concepts into clinical practice, early recognition and targeted interventions may mitigate multi-organ dysfunction and improve patient outcomes.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"340-355"},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of paratracheal pressure on the glottic view during direct laryngoscopy: a randomized, double blind, non-inferiority trial.","authors":"Revanth Kumar, Prakash K Dubey, Akhilesh War","doi":"10.5114/ait/213356","DOIUrl":"10.5114/ait/213356","url":null,"abstract":"<p><strong>Background: </strong>Cricoid pressure (CP) is commonly used during rapid sequence induction and intubation to prevent regurgitation and aspiration of gastric contents. However, its effectiveness and safety have been questioned. Paratracheal pressure (PP) has emerged as a potential alternative. This study aimed to compare the adverse effects of PP versus CP on the glottic view during direct laryngoscopy.</p><p><strong>Material and methods: </strong>This randomized, double-blind, non-inferiority trial included 200 adult patients undergoing general anaesthesia. Participants were randomly assigned to receive either PP or CP during anaesthesia induction. The primary endpoint was the incidence of deteriorated laryngoscopic view, assessed by a blinded observer using the modified Cormack-Lehane grade with a non-inferiority margin of -10%. Secondary endpoints included the percentage of the glottic opening score, ease of mask ventilation, changes in ventilation volume and peak inspiratory pressure (PIP) during mechanical mask ventilation, ease of tracheal intubation, and resistance during tube advancement.</p><p><strong>Results: </strong>PP was found to be non-inferior to CP regarding the incidence of deteriorated laryngoscopic view (0% vs. 20%; absolute risk difference, -20%; 2-sided 95% CI, -26.68 to -13.32; P < 0.001). Mask ventilation was easier with PP (OR, 0.60; 95% CI, 0.15-2.17; P = 0.284). The increase in PIP was significantly smaller in the paratracheal group (0.47 (0.31-0.63) vs. 1.46 (1.22-1.69); P = 0.002).</p><p><strong>Conclusions: </strong>PP is non-inferior to CP concerning its effect on the glottic view during direct laryngoscopy. Additionally, PP may facilitate easier mask ventilation and reduce PIP during mechanical ventilation, making it a viable alternative to cricoid pressure.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"356-364"},"PeriodicalIF":1.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a new ECPR referral center in Poland - first year periprocedural results and patient outcomes.","authors":"Anna Kwinta, Piotr Bielański, Olga Szkudlarek, Tomasz Klimczyk, Tomasz Składzień, Rafał Depukat, Tomasz Lonc, Tomasz Drygalski, Aleksandra Załustowicz, Marcin Krzanowski, Stanisław Bartuś, Michał Terlecki","doi":"10.5114/ait/212549","DOIUrl":"10.5114/ait/212549","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is predominantly performed in high-volume centres with extensive experience, which may limit its adoption by new facilities. However, data from the Extracorporeal Life Support Organization registry indicate that ECPR is often performed in small-volume centres, suggesting potential for its successful implementation. The aim of the study was to assess the first-year periprocedural results and patient outcomes after launching an ECPR programme in a newly established referral centre.</p><p><strong>Methods: </strong>Data from 22 consecutive patients (median age 44.5 years, 77.3% male) who underwent ECPR for out-of-hospital cardiac arrest between May 2023 and May 2024 were retrospectively analysed. The most frequent aetiologies were acute myocardial infarction (31.8%) and pulmonary embolism (22.7%). Periprocedural characteristics, complications, and survival and neurological outcomes at 3 months were assessed.</p><p><strong>Results: </strong>The median cannulation time was 15.5 minutes (IQR: 15.0-20.0) and median time from cardiac arrest to extracorporeal membrane oxygenation flow was 59.5 minutes (IQR: 40.0-78.8). At 3-month follow-up, the survival rate reached 31.8% (7 patients), and a favourable neurological outcome (a score of 1 or 2 on the Cerebral Performance Category Scale) occurred in 27.3% of the study group (6 patients). The cannulation success rate was 100%. In one case, cannulation was complicated by a perforation of the right femoral artery, necessitating endovascular repair.</p><p><strong>Conclusions: </strong>The preliminary results from the first year of our ECPR programme indicate that initiation of such an advanced resuscitative strategy in a newly established centre is achievable, with acceptable short-term clinical and neurological outcomes.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"332-339"},"PeriodicalIF":1.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on anaesthesia in children over 3 years of age.","authors":"Alicja Bartkowska-Śniatkowska, Marzena Zielińska, Magdalena Mierzewska-Schmidt, Jowita Biernawska, Elżbieta Byrska-Maciejasz, Maciej Cettler, Magdalena Chęcicka, Maria Damps, Anna Kubica-Cielińska, Małgorzata Mikaszewska-Sokolewicz, Jowita Rosada-Kurasińska, Beata Rybojad, Tomasz Sikorski, Magdalena Świder, Mariola Tałałaj, Izabela Pągowska-Klimek","doi":"10.5114/ait/211919","DOIUrl":"10.5114/ait/211919","url":null,"abstract":"<p><p>Anaesthesia in children seems to be still a challenge for anaesthetists, who usually anaesthetize adult patients in everyday practice. The principles in the field of pediatric anaesthesiology in Poland are regulated by the regulation of the Minister of the Health on the organizational standard as well as requirements regarding the equipment and staff skills, taking into account the safety and quality of the comprehensive perioperative care in hospitals where those procedures are performed in children. The most important rule in the perioperative care is ERAS concept i.e. improving the results of surgical treatment through a comprehensive approach to child in the perioperative period. Some components of this concept apply to anesthetic field such as shortening fasting time, avoiding pharmacological premedication, multimodal analgesia, prevention nausea and vomiting or emergence delirium. This article presents the updated consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on anesthesia in children over 3 years of age, regarding general and specific recommendations in selected surgical specialties. We hope that this statement, which is a continuation of the statement for children under 3 years, will be of interest to anaesthetists who perform anaesthesia in children and adolescents.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"304-331"},"PeriodicalIF":1.7,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The consensus statement of the Section of Paediatric Anaesthesiology and Intensive Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on anaesthesia in children under 3 years of age.","authors":"Marzena Zielińska, Alicja Bartkowska-Śniatkowska, Magdalena Mierzewska-Schmidt, Jowita Biernawska, Elżbieta Byrska-Maciejak, Maciej Cettler, Magdalena Chęcińska, Maria Damps, Anna Kubica-Cielińska, Małgorzata Mikaszewska-Sokolewicz, Jowita Rosada-Kurasińska, Beata Rybojad, Tomasz Sikorski, Magdalena Świder, Mariola Tałałaj, Izabela Pągowska-Klimek","doi":"10.5114/ait/209457","DOIUrl":"10.5114/ait/209457","url":null,"abstract":"<p><p>The anaesthesia of a young child under 3 years of age is a challenge for every anaesthetist. The peculiarities of this group of patients, particularly neonates and infants, resulting primarily from differences in both physiology, anatomy and the immaturity of individual organs which translate into different pharmacokinetics and pharmacodynamics of the drugs used in anaesthesiology, underlie the significantly more frequently recorded critical events during anaesthesia compared with the adult patient population. Concerned about the safety of children undergoing anaesthesia and aiming to ensure the highest possible quality and uniform standard of anaesthetic services, the Expert Panel of the Section of Paediatric Anaesthesiology and Intensive Care has prepared a Section position paper on anaesthesia in children under 3 years of age.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"276-303"},"PeriodicalIF":1.7,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of erector spinae plane block and quadratus lumborum block on postoperative opioid consumption in laparoscopic prostatectomy: a randomized controlled clinical trial.","authors":"Tomasz Składzień, Pawel Maciejewski, Wojciech Szpunar, Tomasz Lonc, Jan Szpor, Michal Cicio, Olga Szkudlarek, Anna Kwinta, Tomasz Drygalski, Michal Terlecki","doi":"10.5114/ait/210670","DOIUrl":"10.5114/ait/210670","url":null,"abstract":"<p><strong>Background: </strong>The quadratus lumborum block (QLB) and erector spinae (ESP) block are relatively new, regional analgesic techniques adapted to abdominal surgery to reduce opioid consumption in the postoperative period. The aim of this study was to compare the effectiveness of the ultrasound-guided bilateral ESP block and the bilateral QLB for patients undergoing laparoscopic radical prostatectomy (LRP).</p><p><strong>Methods: </strong>Adult patients who underwent LRP were randomly allocated to one of two equal groups. Group I received an ultrasound-guided ESP block with 30 mL of 0.35% ropivacaine on both right and left sides. Group II received an ultrasound-guided QLB1 with 30 mL of 0.35% ropivacaine on both right and left sides.</p><p><strong>Results: </strong>There were 104 included patients, 52 patients in the ESP block group and 52 in the QLB group. There was no statistically significant difference in oxycodone consumption within the first 24 hours after surgery between the groups (P = 0.115, 95% CI, for ESP group 17.32-27.56, and for QLB group 22.04-31.07). Pain was evaluated using Numeric Rating Scale (NRS) at 1, 2, 6, 12, and 24 hours after surgery, with no significant differences between the groups (P = 0.325).</p><p><strong>Conclusions: </strong>Both bilateral QLB and ESP block provided effective postoperative analgesia in patients undergoing LRP. No statistically significant differences were observed between groups in terms of opioid consumption and pain scores during the first 24 hours. However, this trial was not designed or powered to establish equivalence or non-inferiority, and therefore such conclusions cannot be drawn.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"267-275"},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145297968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remimazolam: a comprehensive review.","authors":"Aleksander Aszkiełowicz, Cezary Kapłan, Patrycja Kapica, Rozalia Marszałek","doi":"10.5114/ait/210611","DOIUrl":"10.5114/ait/210611","url":null,"abstract":"<p><p>Remimazolam is a novel, ultra-short-acting benzodiazepine that has emerged as a promising agent in modern anesthetic and intensive care practice. This review pre-sents a detailed analysis of its pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile across various patient populations and procedural contexts. The drug's rapid metabolism by plasma esterases, minimal reliance on hepatic or renal function, and availability of a reversal agent (flumazenil) distinguish it from traditional sedatives such as propofol and midazolam. Clinical data support its utility in procedural sedation, general anesthesia, and ICU sedation, particularly in elderly and hemodynamically unstable patients. Pediatric applications are discussed, highlighting the early evidence and dosing considerations. The review also compares remimazolam with other agents such as propofol and dexmedetomidine, underlining its advantages in cardiovascular stability and recovery profiles. While current results are encouraging, the article emphasizes the need for further research to establish standardized protocols and explore its long-term safety, especially in vulnerable populations.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"257-266"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia: a randomized trial.","authors":"Mostafa Somri, Feras Somri, Luis Gaitini, Anan Safadi, Ayoub Abd El Azim, Ibraheem Mafra, Manuel Ángel Gómez-Ríos","doi":"10.5114/ait/208942","DOIUrl":"10.5114/ait/208942","url":null,"abstract":"<p><strong>Introduction: </strong>Second-generation supraglottic airway devices, such as the laryngeal tube suction disposable (LTS-D) and i-gel, are widely used in pediatric anesthesia due to advantages such as improved sealing and gastric drainage. This randomized controlled trial compared the efficacy and safety of the LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia.</p><p><strong>Material and methods: </strong>Eighty ASA I children aged 2-8 years (12-25 kg), scheduled for short elective surgical procedures, were randomized to the LTS-D (n = 40) or i-gel (n = 40) group. Primary outcomes were oxygen saturation (SpO₂) and end-tidal CO₂ (EtCO₂). Secondary outcomes included insertion time, oropharyngeal leak pressure, fiberoptic view, tidal volumes (Vt), and adverse events.</p><p><strong>Results: </strong>Both devices maintained comparable oxygenation. Mean EtCO₂ was slightly higher in the i-gel group, with a mean difference of 2.56 mmHg (95% CI: 1.86-3.26; P < 0.001). The i-gel had significantly faster insertion times (24.53 ± 2.00 s vs. 31.20 ± 1.95 s; P < 0.001) and superior fiberoptic visualization (optimal grades in 99% vs. 70%; P < 0.001). The LTS-D showed higher oropharyngeal leak pressures (37.63 ± 3.71 cmH₂O vs. 24.43 ± 1.72 cmH₂O; P < 0.001). Vt and adverse event rates were similar, with no severe complications reported (P = 0.65).</p><p><strong>Conclusions: </strong>Both the LTS-D and i-gel are safe and effective for airway management in non-paralyzed children undergoing short procedures. The i-gel enables faster insertion and better anatomical positioning, while the LTS-D offers higher leak pressures, making it preferable when a better seal is needed. Device choice should be guided by clinical context and patient characteristics.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"248-256"},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of the end inspiratory pause on ventilatory efficiency and respiratory mechanics in patients undergoing robotic surgery under a tailored open lung approach: a prospective-paired study.","authors":"Manuel de la Matta, Minia Bastón-Castiñeiras, Daniel López-Herrera","doi":"10.5114/ait/209514","DOIUrl":"10.5114/ait/209514","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of modifying the end inspiratory pause (EIP) on the variations in the physiological dead space (VDphys) in patients undergoing robotic surgery ventilated under a tailored open lung approach has not been addressed before.</p><p><strong>Material and methods: </strong>This prospective-paired study was carried out in a tertiary hospital. Following an alveolar recruitment manoeuvre (ARM) and the application of a tailored open-lung positive end-expiratory pressure (PEEPOL), participants consecutively received three EIP levels (30%, 40%, and 10%). The sequence was repeated after pneumoperitoneum and the Trendelenburg position and following a second ARM for patients with suspected lung collapse based on an Air test.</p><p><strong>Results: </strong>Eighteen adult subjects were included. The use of an EIP of 10% was asso-ciated with a higher VDphys, both before pneumoperitoneum: 210 mL (IQR 200-237) vs. 197 mL (IQR 173-217) and 196.8 (IQR 185-218) with EIP 30% and 40%, respectively (<i>P</i> < 0.001 and <i>P</i> = 0.006) and after pneumoperitoneum: 212 mL (IQR 198-228) vs. 202 mL (IQR 181-213), <i>P</i> = 0.001. The application of ARMs and PEEPOL led to a significant reduction in driving pressure [5 cmH₂O (IQR 5-6) vs. 7 cmH₂O (IQR 6-10), <i>P</i> < 0.001], despite concurrent increases in PEEP [12 cmH₂O (IQR 10-13) vs. 5 cmH₂O, <i>P</i> < 0.001] and plateau pressure [17 cmH₂O (IQR 16-19) vs. 12 cmH₂O (IQR 12-15)].</p><p><strong>Conclusions: </strong>The use of an EIP of 30-40% compared to 10% in patients undergoing robotic surgery optimises lung mechanics and minimises ventilation inefficiencies both before and during the establishment of pneumoperitoneum and Trendelenburg positioning.</p>","PeriodicalId":7750,"journal":{"name":"Anaesthesiology intensive therapy","volume":"57 1","pages":"239-247"},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}