PEEP Strategies and Mechanical Power in Robotic Surgery

NCT07536464 | Not Yet Recruiting

• 1 other identifier: E26-14833
• Study Type: interventional
• Target: 120
• Locations: 0 countries
• Sites: N/A

Brief Summary

Robotic surgery requires pneumoperitoneum and steep Trendelenburg positioning, which significantly impair respiratory mechanics and increase the risk of postoperative pulmonary complications. Positive end-expiratory pressure (PEEP) is a key determinant of lung recruitment; however, fixed PEEP strategies may not be optimal for all patients. Individualized PEEP titration strategies, including incremental and decremental approaches, may better optimize lung mechanics. This randomized controlled trial aims to compare the effects of incremental, decremental, and fixed PEEP strategies on cumulative mechanical power (MP-AUC) and postoperative oxygenation in patients undergoing robotic surgery.

Conditions

Postoperative Pulmonary Complications; Impaired Oxygenation; Mechanical Ventilation

Outcome Measures

Primary Outcomes (1)

• Cumulative Mechanical Power (MP-AUC)

  Total energy delivered to the respiratory system during surgery

  During surgery (from intubation to extubation)

Secondary Outcomes (3)

• PaO₂/FiO₂ ratio

  Intraoperative period and postoperative period (within 2 hours)

• Oxygenation Index (OSI)

  Postoperative 2 hours

• Postoperative Pulmonary Complications (PPC)

  Within 7 postoperative days

Study Arms (3)

Fixed PEEP

ACTIVE COMPARATOR

Ventilation with constant PEEP of 5 cmH₂O throughout surgery.

Procedure: Fixed PEEP Ventilation; Procedure: Decremental PEEP Strategy; Procedure: Incremental PEEP Strategy

Decremental PEEP

EXPERIMENTAL

PEEP is gradually decreased to identify the level associated with the lowest driving pressure or lowest mechanical power.

Procedure: Fixed PEEP Ventilation; Procedure: Decremental PEEP Strategy; Procedure: Incremental PEEP Strategy

Incremental PEEP

EXPERIMENTAL

PEEP is gradually increased to determine the optimal level corresponding to the lowest driving pressure or mechanical power.

Procedure: Fixed PEEP Ventilation; Procedure: Decremental PEEP Strategy; Procedure: Incremental PEEP Strategy

Interventions

Fixed PEEP Ventilation PROCEDURE

Patients receive mechanical ventilation with a constant positive end-expiratory pressure (PEEP) of 5 cmH₂O throughout the surgical procedure.

Decremental PEEP; Fixed PEEP; Incremental PEEP

Decremental PEEP Strategy PROCEDURE

PEEP is gradually decreased from a higher level to determine the optimal PEEP associated with the lowest driving pressure or lowest mechanical power, and this level is maintained during surgery.

Decremental PEEP; Fixed PEEP; Incremental PEEP

Incremental PEEP Strategy PROCEDURE

PEEP is gradually increased from a lower level to identify the optimal PEEP corresponding to the lowest driving pressure or mechanical power, and this level is maintained during surgery.

Decremental PEEP; Fixed PEEP; Incremental PEEP

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age\>= 18
• ASA I-III
• Elective robotic surgery

You may not qualify if:

• COPD GOLD ≥2
• Restrictive lung disease
• BMI \>40 kg/m²
• Heart failure
• Preoperative oxygen requirement
• Need for postoperative mechanical ventilation
• Refusal to participate

Sponsors & Collaborators

• Ankara City Hospital Bilkent: lead

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assos prof

Study Record Dates

• First Submitted: April 11, 2026
• First Posted: April 17, 2026
• Study Start: April 15, 2026
• Primary Completion: May 1, 2026
• Study Completion (Estimated): June 30, 2026
• Last Updated: April 17, 2026

Record last verified: 2026-04