Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)—Interim Analysis of DESIGNATION
Issued Date
2024-01-01
Resource Type
eISSN
20770383
Scopus ID
2-s2.0-85181913578
Journal Title
Journal of Clinical Medicine
Volume
13
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Medicine Vol.13 No.1 (2024)
Suggested Citation
Nijbroek S.G.L.H., Hol L., Serpa Neto A., van Meenen D.M.P., Hemmes S.N.T., Hollmann M.W., Schultz M.J. Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)—Interim Analysis of DESIGNATION. Journal of Clinical Medicine Vol.13 No.1 (2024). doi:10.3390/jcm13010209 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/95804
Title
Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)—Interim Analysis of DESIGNATION
Corresponding Author(s)
Other Contributor(s)
Abstract
Uncertainty remains about the best level of intraoperative positive end–expiratory pressure (PEEP). An ongoing RCT (‘DESIGNATION’) compares an ‘individualized high PEEP’ strategy (‘iPEEP’)—titrated to the lowest driving pressure (ΔP) with recruitment maneuvers (RM), with a ‘standard low PEEP’ strategy (‘low PEEP’)—using 5 cm H2O without RMs with respect to the incidence of postoperative pulmonary complications. This report is an interim analysis of safety and feasibility. From September 2018 to July 2022, we enrolled 743 patients. Data of 698 patients were available for this analysis. Hypotension occurred more often in ‘iPEEP’ vs. ‘low PEEP’ (54.7 vs. 44.1%; RR, 1.24 (95% CI 1.07 to 1.44); p < 0.01). Investigators were compliant with the study protocol 285/344 patients (82.8%) in ‘iPEEP’, and 345/354 patients (97.5%) in ‘low PEEP’ (p < 0.01). Most frequent protocol violation was missing the final RM at the end of anesthesia before extubation; PEEP titration was performed in 99.4 vs. 0%; PEEP was set correctly in 89.8 vs. 98.9%. Compared to ‘low PEEP’, the ‘iPEEP’ group was ventilated with higher PEEP (10.0 (8.0–12.0) vs. 5.0 (5.0–5.0) cm H2O; p < 0.01). Thus, in patients undergoing general anesthesia for open abdominal surgery, an individualized high PEEP ventilation strategy is associated with hypotension. The protocol is feasible and results in clear contrast in PEEP. DESIGNATION is expected to finish in late 2023.