Individualised Positive End‐Expiratory Pressure During Robotic‐Assisted Radical Prostatectomy Guided by Intratidal Compliance–Volume Curve Analysis

Abstract

ABSTRACT Background Steep Trendelenburg positioning and capnoperitoneum during robotic‐assisted prostatectomy adversely affect respiratory system mechanics and decrease dorsal lung ventilation. Objective We hypothesised that individualising positive end‐expiratory pressure (PEEP) based on intratidal compliance–volume curve analysis enhances dorsal regional lung ventilation. Methods Thirty male patients undergoing robotic‐assisted prostatectomy received a tidal volume of 7 mL kg −1 and a PEEP of 7 cmH 2 O. PEEP was increased in steps of 3 cmH 2 O until a predominance of horizontal intratidal compliance profiles occurred or a PEEP of 22 cmH 2 O was reached. The primary endpoint was the share of dorsal lung ventilation. Secondary endpoints included respiratory system mechanics, oxygenation, and haemodynamics. Results Best PEEP was 20.6 ± 2.7 cmH 2 O. At best PEEP, defined as a predominance of horizontal intratidal compliance profiles, the share of dorsal ventilation was increased by 41% compared with PEEP 7 cmH 2 O ( p < 0.001) and oxygenation improved [ P a O 2 /F i O 2 417 mmHg (95% CI 387–446) vs. 400 mmHg (95% CI 365–436), p = 0.016]. Aside from a slight increase in norepinephrine dosage [0.054 μg kg −1 min −1 (95% CI 0.043–0.066) vs. 0.048 μg kg −1 (95% CI 0.037–0.059), p = 0.01], haemodynamic parameters were not affected by PEEP. Conclusion Individualised PEEP guided by intratidal compliance–volume curve analysis enhanced dorsal lung ventilation, reduced driving pressure, and improved oxygenation during robotic‐assisted prostatectomy. Trial Registration: DRKS00021009 ( ClinicalTrials.gov identifier: DRKS00021009)