EIT-guided PEEP Titration Versus Standard Ventilation in Bariatric Surgery
Prevention of Postoperative Pulmonary Complications in Patients Undergoing Laparoscopic Gastric Sleeve Resection by PEEP Titration Based on EIT: A Randomized Controlled Study
Jianbo Wu
118 participants
Jul 28, 2025
INTERVENTIONAL
Conditions
Summary
This study is a prospective, single-center, single-blind, randomized controlled clinical trial. Patients scheduled for laparoscopic bariatric surgery will be selected and randomly assigned to either the EIT-guided individualized PEEP group (Group P-eit) or the control group (Group P-8). Group P will be ventilated using the PEEP value determined by EIT, while Group C will be ventilated with a fixed PEEP value of 8 cmH2O.The primary outcome is the incidence of postoperative pulmonary complications (PPCs) within 72 hours after surgery.
Eligibility
Inclusion Criteria5
- Age between 18 and 65 years;
- Plan to receive laparoscopic bariatric surgery under general anesthesia;
- American Society of Anaesthesiologists (ASA) physical status I-III;
- BMI between 30 and 55 kg/m2;
- Voluntary participation in this study and signing of an informed consent form.
Exclusion Criteria10
- History of smoking or previous thoracic surgery;
- Invasive mechanical ventilation within 30 days;
- Pregnancy;
- Allergy to EIT electrodes;
- Persistent hemodynamic instability or refractory shock;
- Severe cardiopulmonary disease (e.g., severe COPD (Chronic obstructive pulmonary disease), NYHA (New York Heart Association) Class III or IV, acute coronary syndrome, or sustained ventricular tachycardia);
- Severe pulmonary hypertension (systolic pulmonary artery pressure \>40 mmHg);
- Increased intracranial pressure, intracranial injury/tumor, or neuromuscular disorders;
- Conversion to laparotomy;
- Planned transfer to intensive care unit after surgery.
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Interventions
"The Recruitment Maneuver - PEEP Titration - Recruitment Maneuver (RM-T-R) Strategy" will be implemented 5 minutes after endotracheal intubation. The patient will receive an RM (peak pressure 50cm H2O, PEEP 25cmH2O, respiratory rate 6 bpm, for 10 cycles) followed by a decremental PEEP titration, during which PEEP is set to 25cm H2O and decreased stepwise by 2cm H2O every 3min until reaching 5 cmH₂O. Meanwhile, the ventilator parameters (tidal volume, respiratory rate, and inspiratory-to-expiratory ratio) will be adjusted back to their pre-recruitment settings. EIT-based optimal PEEP is defined as the crossing point of the overdistension and collapse curves during a decremental PEEP trial.
In group p-8, mechanical ventilation will be administered in volume-controlled mode with a tidal volume of 8 ml/kg (based on ideal body weight). Additional settings include a PEEP of 8 cmH₂O, FiO₂ of 0.5, an inspiratory-to-expiratory ratio of 1:2, and a respiratory rate of 12 breaths/min. A recruitment maneuver (RM) will be performed 5 minutes after intubation and again after surgery, using the same protocol as in group P-eit. The respiratory rate will be adjusted as needed to maintain end-tidal CO₂ between 35 and 45 mmHg throughout the procedure.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT07207772