Perioperative medicine & outcomes
Intraoperative Driving Pressure–Guided High Positive End-expiratory Pressure (PEEP) vs Standard Low PEEP for Postoperative Pulmonary Complications
Primary resultResult — go to the resultAbsolute difference 2.5% 95% CI −1.5% to 6.4%Authors' conclusion
Among patients at increased risk for postoperative pulmonary complications undergoing open abdominal surgery under general anesthesia, intraoperative ventilation with driving pressure-guided high PEEP and recruitment maneuvers, compared with a strategy with standard low PEEP, did not reduce postoperative pulmonary complications.
Study context
- Population
- Adults at increased risk for PPCs scheduled for open abdominal surgery; 29 sites in 5 European countries, 2019–2024of 1468 adults
- Participants
- 1,435 adults
- Comparison
- High PEEP vs Low PEEP
- High PEEPn = 718
- Low PEEPn = 717reference
- Primary endpoint
- Composite of PPCs (severe respiratory failure, bronchospasm, suspected pulmonary infection, pulmonary infiltrates, aspiration pneumonitis, atelectasis, ARDS, pleural effusion, cardiopulmonary edema, pneumothorax)
- Follow-up
- First 5 postoperative days
Methodological detailsmulticentre, All patients received low tidal volume ventilation
- Multicentre
- All patients received low tidal volume ventilation
Primary result
As reported in the abstract
Absolute difference
2.5%
95% CI −1.5% to 6.4%
P = 0.23
Events by treatment group
High PEEP vs Low PEEP
absolute difference 2.5% (95% CI −1.5% to 6.4%); P = 0.23
Safety
Intraoperative hypotension (MAP decrease >20% for >3 minutes)
Use of vasoactive agents
Intraoperative desaturation (SpO2 <92% for >1 minute)
Original publication
Intraoperative Driving Pressure–Guided High PEEP vs Standard Low PEEP for Postoperative Pulmonary Complications. JAMA. Published 24 February 2026. doi:10.
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