Effect of intraoperative positive end-expiratory pressure on post-operative pulmonary complications in overweight patients undergoing elective laparoscopic hernia surgery: A prospective randomised controlled trial.

Introduction: Post-operative pulmonary complications (PPCs) are a significant cause of morbidity following surgery. This study evaluated the effect of intraoperative positive end-expiratory pressure (PEEP) on PPCs in overweight patients undergoing elective laparoscopic hernia surgery.

Patients and methods: In this randomised controlled trial, 60 patients with a body mass index between 25 and 30 kg/m² were divided equally into a standard PEEP group (5 cm H2O) and a high PEEP group (10 cm H2O). The primary outcome was the incidence of PPCs, with secondary outcomes assessing intraoperative respiratory mechanics, haemodynamics and post-operative oxygenation levels.

Results: Both groups demonstrated comparable demographic and baseline characteristics. The results showed a significant reduction in the incidence of PPCs in the high PEEP group, with atelectasis observed in 16% of control patients versus 6% of those receiving higher PEEP. In addition, the high PEEP group exhibited improved dynamic lung compliance and oxygenation but had an increased mean arterial pressure, indicating haemodynamic effects associated with higher PEEP levels. While the Cabrini Respiratory Strain Score and air test scores were comparable, patients in the high PEEP group had shorter durations of supplemental oxygen therapy and improved post-operative oxygenation at 6, 12 and 24 h.

Conclusion: These findings suggest that high PEEP may enhance lung mechanics and oxygenation while reducing PPCs in overweight patients, although careful monitoring of haemodynamic stability is recommended.