Intraoperative Driving Pressure–Guided High PEEP vs Standard Low PEEP for Postoperative Pulmonary Complications

Do intraoperative driving pressure–guided high positive end-expiratory pressure (PEEP) and recruitment maneuvers decrease postoperative pulmonary complications in patients undergoing open abdominal surgery compared with standard low PEEP without recruitment maneuvers?In this randomized clinical trial of 1435 adult patients undergoing open abdominal surgery under general anesthesia, the rate of postoperative pulmonary complications was 19.8% among those randomized to undergo driving pressure–guided high PEEP compared with 17.4% among those randomized to undergo standard low PEEP; the difference was not statistically significant.An intraoperative ventilation strategy targeting the lowest driving pressure through individualized PEEP and recruitment maneuvers did not reduce postoperative pulmonary complications in patients undergoing open abdominal surgery.

Corresponding Author: David M. P. van Meenen, MD, PhD, Department of Anaesthesiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands (d.m.vanmeenen@amsterdamumc.nl).

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