- Design
- Single-centre parallel-group randomised trial
- Population
- 117 adults at intermediate-high pulmonary risk having laparoscopic colorectal surgery
- Primary outcome
- Postoperative pulmonary complications within 30 days
- Effect
- 49.2% vs 72.4%; HR 0.53 (95% CI 0.33-0.85)
Pneumoperitoneum and steep head-down positioning drive atelectasis. This single-centre trial randomised 117 adults at intermediate-to-high pulmonary risk (ARISCAT 26 or more) having laparoscopic colorectal surgery to PEEP titrated by electrical impedance tomography (EIT) or a fixed PEEP of 5 cmH₂O.
Driving pressure was lower with EIT-guided PEEP (median 16 vs 19 cmH₂O). Pulmonary complications within 30 days, adjudicated by a blinded team, occurred in 49.2% vs 72.4% (HR 0.53, 95% CI 0.33-0.85), with less atelectasis and pneumonia.
This is a small single-centre trial, and complication rates in both arms were high, so the size of the effect may not hold elsewhere. Fixed PEEP of 5 is also a low comparator.
EIT is not widely available. The reasonable message is that individualised PEEP in high-risk laparoscopic surgery deserves attention, by whatever method a unit has.
- EIT-guided PEEP lowered driving pressure by about 3 cmH₂O.
- Pulmonary complications fell from 72.4% to 49.2% in this trial.
- Patients had ARISCAT scores of 26 or more, in steep head-down laparoscopy.
- Fixed PEEP of 5 cmH₂O was the comparator — a low bar in pneumoperitoneum.
- Watch driving pressure as a bedside guide where EIT is not available.
Why it matters
It adds clinical-outcome evidence to the physiological case for individualised PEEP under pneumoperitoneum.
Don't overread it
One small single-centre trial against fixed PEEP of 5 does not establish EIT as standard care.
The statistics, in plain English
A hazard ratio of 0.53 is a large effect, but in 117 patients the interval (0.33-0.85) is wide. Small trials with large effects often shrink on replication.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free