Driving Pressure-Guided Ventilation in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

PURPOSE: This study aims to compare the conventional lung protective ventilation strategy (LPVS) with driving pressure-guided ventilation in obese patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: Forty-five patients undergoing elective LSG under general anesthesia were randomly assigned to the conventional LPVS group (group L) or the driving pressure-guided ventilation group (group D) using random numbers generated by Excel. The primary outcome was the driving pressure of both groups 90 min after pneumoperitoneum. RESULTS: After 30 min of pneumoperitoneum, 90 min of pneumoperitoneum, 10 min of closing the pneumoperitoneum, and restoring the supine position, the driving pressure of group L and group D were 20.0 ± 2.9 cm H(2)O vs 16.6 ± 3.0 cm H(2)O (P < 0.001), 20.7 ± 3.2 cm H(2)O vs 17.3 ± 2.8 cm H(2)O (P < 0.001), and 16.3 ± 3.1 cm H(2)O vs 13.3 ± 2.5 cm H(2)O (P = 0.001), respectively; the respiratory compliance of groups L and D were 23.4 ± 3.7 mL/cm H(2)O vs 27.6 ± 5.1 mL/cm H(2)O (P = 0.003), 22.7 ± 3.8 mL/cm H(2)O vs 26.4 ± 3.5 mL/cm H(2)O (P = 0.005), and 29.6 ± 6.8 mL/cm H(2)O vs 34.7 ± 5.3 mL/cm H(2)O (P = 0.007), respectively. The intraoperative PEEP in groups L and group D was 5 (5–5) cm H(2)O vs 10 (9–11) cm H(2)O (P < 0.001). CONCLUSION: An individualized peep-based driving pressure-guided ventilation strategy can reduce intraoperative driving pressure and increase respiratory compliance in obese patients undergoing LSG.