Safety and Feasibility of Intraoperative High PEEP Titrated to the Lowest Driving Pressure (ΔP)—Interim Analysis of DESIGNATION

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 p 2O; 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.

Keywords

• anesthesia
• intraoperative ventilation
• ventilation
• positive end–expiratory pressure
• PEEP
• recruitment maneuver