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NCT Number: NCT07536464

PEEP Strategies and Mechanical Power in Robotic Surgery

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.

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Key information

Conditions

Postoperative Pulmonary Complications Impaired Oxygenation Mechanical Ventilation

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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

Exclusion criteria

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

Treatment and study plan

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 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.

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.

Primary outcomes

  1. Cumulative Mechanical Power (MP-AUC)

    Time frame: During surgery (from intubation to extubation)

    Total energy delivered to the respiratory system during surgery

Secondary outcomes

  1. PaO₂/FiO₂ ratio

    Time frame: Intraoperative period and postoperative period (within 2 hours)

  2. Oxygenation Index (OSI)

    Time frame: Postoperative 2 hours

  3. Postoperative Pulmonary Complications (PPC)

    Time frame: Within 7 postoperative days

Sponsors and collaborators

Lead sponsor

Ankara City Hospital Bilkent

Other

Registry information

Official study title

Comparison of Incremental, Decremental, and Fixed PEEP Strategies on Mechanical Power and Postoperative Oxygenation in Robotic Surgery: A Prospective Randomized Controlled Trial

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Apr 17, 2026
Registry last updated
Apr 17, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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