Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2026 Jul 28;51(7):1438-1448. doi: 10.11817/j.issn.1672-7347.2026.260205.
ABSTRACT
OBJECTIVES: A lung recruitment maneuver (LRM) combined with a dynamic lung compliance-guided positive end-expiratory pressure (PEEP) strategy can reduce the risk of postoperative pulmonary complications (PPCs) in patients undergoing pulmonary resection. However, the lung-protective effects of this strategy and its impact on hemodynamics in patients with hypertension remain unclear. This study aims to evaluate the effects of an LRM combined with a dynamic lung compliance-guided PEEP strategy on PPCs and perioperative hemodynamics in hypertensive patients undergoing thoracoscopic pulmonary resection, thereby providing scientific evidence for the safe application of this strategy in this population.
METHODS: A total of 100 hypertensive patients scheduled to undergo thoracoscopic pulmonary resection with one-lung ventilation (OLV) at the Affiliated Hospital of Jiangnan University between November 28, 2024 and August 15, 2025 were enrolled. Using a random number table, the patients were assigned to a conventional protective ventilation group (control group) or an LRM combined with individualized PEEP group (intervention group), with 50 patients in each group. In the control group, intraoperative PEEP was set at 5 cmHO (1 cmHO=0.098 kPa). In the intervention group, an LRM followed by decremental PEEP titration was performed after the initiation of OLV, and the optimal PEEP was determined according to dynamic lung compliance. Before the end of OLV, an LRM was performed once in both groups. The primary outcome was the incidence of PPCs within 5 days after surgery. Secondary outcomes included the incidence of intraoperative hypotension, use of vasoactive drugs, incidence of arrhythmia and hypotension within 5 days after surgery, postoperative renal function indices, and length of postoperative hospital stay.
RESULTS: There were no statistically significant differences in preoperative baseline characteristics between the control and intervention groups (all P>0.05). Compared with the control group, the intervention group had higher intraoperative PEEP, lower driving pressure, and slightly higher airway plateau pressure (Pplat), pulse oxygen saturation (SpO), and dynamic lung compliance (all P<0.05). The incidence of intraoperative hypotension was higher in the intervention group than in the control group [52% (26/50) vs 30% (15/50), P<0.05], as was the intraoperative use of vasoactive drugs [54% (27/50) vs 20% (10/50), P<0.05]. No statistically significant differences were observed between the 2 groups in surgical site, type of surgery, heart rate, mean arterial pressure (MAP), pulse pressure variation (PPV), intraoperative fluid volume, respiratory rate, or tidal volume (all P>0.05). The incidence of PPCs was lower in the intervention group than in the control group [22% (11/50) vs 42% (21/50), P<0.05]. There were no statistically significant differences between the 2 groups in postoperative arrhythmia, postoperative hypotension, or length of hospital stay (all P>0.05). In both the intervention and control groups, serum creatinine (SCr) and blood urea nitrogen (BUN) levels on postoperative day 1 and BUN levels on postoperative day 3 were higher than their respective preoperative levels (all P<0.05). No statistically significant between-group differences were observed in SCr or BUN levels preoperatively or on postoperative days 1, 3, and 5 (all P>0.05). After multivariable logistic regression adjustment for age, body mass index (BMI), hypertension grade, American Society of Anesthesiologists (ASA) physical status, and type of surgery, the risk of intraoperative hypotension in the intervention group was 2.8 times that in the control group (OR=2.8, 95% CI 1.2 to 6.9; P<0.05). Subgroup analysis for intraoperative hypotension showed that patients aged ≥65 years, those with a BMI >24 kg/m2, grade 3 hypertension, ASA physical status III, or those scheduled to undergo segmentectomy were more likely to develop intraoperative hypotension when receiving the LRM combined with individualized PEEP strategy.
CONCLUSIONS: An LRM combined with individualized PEEP can reduce the incidence of PPCs. Although this strategy is associated with a higher incidence of intraoperative hypotension, most episodes can be rapidly corrected with timely intervention, are of short duration, and do not adversely affect postoperative cardiac or renal function. Older patients, those with grade 3 hypertension, and overweight patients may be at greater risk of intraoperative hypotension; therefore, enhanced intraoperative hemodynamic monitoring and timely individualized management are warranted.
PMID:42763299 | DOI:10.11817/j.issn.1672-7347.2026.260205