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Driving Pressure-Guided Individualized PEEP Versus Standard PEEP: Effects on Postoperative Pulmonary Complications in Upper Abdominal Digestive Surgery
Sponsor: Hopital Charles Nicolle
Summary
This randomized clinical trial compares two methods of setting positive end-expiratory pressure (PEEP) during general anesthesia in adults undergoing upper abdominal digestive surgery who are at moderate or high risk of postoperative pulmonary complications. All participants will receive lung-protective mechanical ventilation. Participants will be randomly assigned to one of two groups. In the individualized PEEP group, PEEP will be adjusted to achieve the lowest driving pressure following a lung recruitment maneuver. In the standard PEEP group, PEEP will be fixed at 5 cmH2O. The main question is whether driving pressure-guided individualized PEEP reduces the proportion of participants who develop one or more postoperative pulmonary complications during the first 7 days after surgery compared with standard PEEP.
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
210
Start Date
2026-05-22
Completion Date
2027-06-22
Last Updated
2026-10-21
Healthy Volunteers
No
Interventions
Driving Pressure-Guided Individualized PEEP
Participants assigned to this experimental arm receive a lung recruitment maneuver followed by a decremental PEEP trial. Driving pressure is calculated as plateau pressure minus PEEP at each tested level. The PEEP associated with the lowest driving pressure is selected and maintained during surgery, provided that adequate oxygenation and hemodynamic stability are preserved.
Standard PEEP
Participants receive lung-protective mechanical ventilation with PEEP fixed at 5 cmH2O throughout the intraoperative ventilation period. The other components of perioperative ventilation and care are standardized between the two groups.
Locations (1)
Charles Nicole Hospital
Tunis, Tunisia