EFFECT OF INTRAOPERATIVE LUNG PROTECTIVE VENTILATION STRATEGIES ON POSTOPERATIVE PULMONARY COMPLICATIONS IN OBESE PATIENTS UNDERGOING SURGERY

Abstract

Background:

Obesity is associated with an increased risk of postoperative pulmonary complications (POPC) due to altered respiratory mechanics and decreased lung volumes. Intraoperative mechanical ventilation plays a critical role in optimizing gas exchange, but traditional high tidal volume strategies may exacerbate lung injury. Lung protective ventilation (LPV) strategies — including lower tidal volumes, individualized positive end-expiratory pressure (PEEP), and periodic recruitment maneuvers — have been shown to improve respiratory outcomes in critically ill patients, but their effects in obese surgical patients remain underexplored.

Methods:

In this prospective, randomized controlled trial, 60 obese patients (BMI ≥30 kg/m²) undergoing elective non-cardiac surgery under general anesthesia were randomized to receive either LPV (tidal volume 6–8 mL/kg predicted body weight, PEEP 5–10 cmH₂O, recruitment maneuvers every 30–60 minutes) or conventional ventilation (tidal volume 10–12 mL/kg, PEEP ≤2 cmH₂O or none, no recruitment maneuvers). The primary outcome was POPC incidence within 7 days postoperatively (atelectasis, pneumonia, hypoxemia, or need for postoperative non-invasive ventilation). Secondary outcomes included intraoperative oxygenation, hospital stay length, and ICU admission rate.

Results:

The incidence of POPC was significantly lower in the LPV group (16.7%) compared to the conventional ventilation group (31.7%) (p < 0.05). LPV was associated with better intraoperative oxygenation, fewer cases of hypoxemia, reduced rates of atelectasis and pneumonia, and less frequent need for postoperative non-invasive ventilation. LPV patients also had a shorter median hospital stay.

Conclusions:

Intraoperative application of lung protective ventilation strategies in obese surgical patients significantly reduces the risk of postoperative pulmonary complications and enhances postoperative recovery. These findings support the routine adoption of LPV in this high-risk population.