Observational studyMedical science monitor : international medical journal of experimental and clinical research2025
Optimizing Ventilation Strategies to Reduce Pulmonary Complications in Frail Patients: A Comparative Study.
Observational study in Medical science monitor : international medical journal of experimental and clinical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND Frailty is a clinical syndrome with reduced physiological reserve and diminished resilience to surgical stress, predisposing patients to postoperative pulmonary complications (PPCs). This prospective observational study included 61 frail patients undergoing non-cardiac surgery (NCS) and aimed to compare postoperative pulmonary outcomes between standard positive end-expiratory pressure (PEEP) ventilation and driving pressure-guided individualized ventilation. MATERIAL AND METHODS Patients were assigned to either a driving pressure-guided ventilation group (DP group, n=31) or a standard PEEP ventilation group (N group, n=30). The ΔP group received individualized PEEP titrated to minimize driving pressure (plateau pressure minus PEEP), while the N group received a fixed PEEP of 5 cmH₂O. The primary outcome was the incidence of PPCs within 7 days. Secondary outcomes included plateau pressure (Pplat), airway pressure (Paw), dynamic lung compliance (Cdyn), arterial oxygen pressure (PaO₂), and oxygenation index (OI), measured at 4 time points (T0: post-intubation; T1: 60 min after PEEP titration; T2: end of surgery; T3: 24 h postoperatively). RESULTS No PPCs occurred in the ΔP group, whereas 7 patients (23.3%) in the N group developed PPCs (P<0.01). The ΔP group also showed significantly lower Pplat and Paw and improved Cdyn at T0 (P<0.001), with no significant differences in PaO₂ or OI throughout the study period (P>0.05). CONCLUSIONS Driving pressure-guided individualized ventilation significantly reduced PPCs and improved perioperative respiratory parameters in frail patients undergoing NCS. This strategy may help optimize intraoperative ventilation in similar high-risk surgical patients.
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