ArticleAnesthesia and pain medicine2026
Driving pressure guided ventilation in robot-assisted laparoscopic surgery with steep Trendelenburg position: a randomized controlled study.
Article in Anesthesia and pain medicine, 2026. 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
backgroundRobot-assisted laparoscopic prostatectomy (RALP) with pneumoperitoneum and steep Trendelenburg positioning impairs ventilation and increases the risk of postoperative pulmonary complications (PPCs). Although positive end-expiratory pressure (PEEP) may reduce atelectasis, the optimal levels remain unclear. This study evaluated the effects of driving pressure (DP)-guided PEEP titration during RALP.
methodsThis single-center, randomized controlled trial enrolled adults undergoing RALP (American Society of Anesthesiologists < 3, without pulmonary disease) for either DP minimization-guided individualized PEEP (DP group) or fixed 5 cmH2O PEEP (control). DP was calculated as plateau pressure minus PEEP, with individualized PEEP determined using decremental titration. Atelectasis was quantified using modified lung ultrasound (LUS) score, incorporating B-lines and consolidations. Primary outcome was LUS score at end-Trendelenburg. Secondary outcomes included oxygenation and PPCs.
resultsOf 101 assessed, 63 completed analysis. The DP group (n=31) received higher individualized PEEP (median 8.0 cmH2O) during Trendelenburg than controls (5.0 cmH2O, n=32). In the DP group, mean DP was lower during Trendelenburg (19.0 ± 3.4 vs. 21.3 ± 4.7 cmH2O, P=0.035) and LUS score was significantly lower at the end-Trendelenburg (median [1Q, 3Q]: 9.0 [8.0, 11.5] vs. 11.0 [9.0, 13.0]; median difference, -2.0 [95% CI, -3.0 to 0.0]; P=0.032) and recovery (9.0 vs. 13.5, P<0.001). Intraoperative PaO2 during Trendelenburg was higher in the DP group (154.6 ± 33.1 vs. 133.3 ± 34.7 mmHg, P=0.015). PPCs and hospital stay were comparable between groups.
conclusionsDP-guided PEEP titration during RALP reduced lung de-aeration burden assessed by modified LUS score, though benefits did not translate to reduced PPCs.
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