EIT-guided PEEP titration improves oxygenation and respiratory mechanics in lateral decubitus laparoscopic surgery

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Korean journal of anesthesiology Published April 4, 2026 Medically reviewed May 26, 2026 Study authors: Kim Yoon Jung, Lee Hyeonhoon, Yoon Hyun-Kyu, Kim Hee-Soo PubMed ↗ DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider EIT-guided PEEP for intraoperative oxygenation in lateral decubitus surgery, but clinical benefits remain uncertain.

This randomized controlled trial enrolled 74 adult patients undergoing robot-assisted or laparoscopic urologic surgery in the lateral decubitus position, with 71 completing the study. The intervention group received electrical impedance tomography (EIT)-guided decremental PEEP titration to determine and maintain optimal PEEP throughout surgery, while the control group received fixed PEEP of 5 cmH2O.

The primary outcome, PaO2/FiO2 ratio at the end of surgery, was significantly higher in the EIT-guided group (523.8 ± 82.4 mmHg) compared to the fixed PEEP group (414.6 ± 96.7 mmHg, P < 0.001). Driving pressure was also lower in the EIT-guided group at 30 minutes after pneumoperitoneum initiation (15.8 [12.5, 17.4] vs. 19.9 [17.2, 22.5] cmH2O, P < 0.001) and at the end of surgery (9.1 [8.0, 10.4] vs. 10.0 [8.8, 12.6] cmH2O, P = 0.033). However, postoperative pulmonary complications until discharge did not differ between groups.

Safety data were not reported, and 3 patients did not complete the study. Limitations were not reported in the available data. While EIT-guided PEEP titration demonstrated improved intraoperative oxygenation and respiratory mechanics in this specific surgical population, the lack of difference in postoperative pulmonary complications suggests these physiological improvements may not translate to meaningful clinical benefits. Further research is needed to determine if this approach affects patient-centered outcomes.

Study Details

Study typeRct

EvidenceLevel 2

PublishedApr 2026

PMID41839618

View Original Abstract ↓

BACKGROUND: Laparoscopic surgery in the lateral decubitus position can alter pulmonary mechanics and oxygenation. Although positive end-expiratory pressure (PEEP) may alleviate these effects, the optimal level remains unclear. This study evaluated whether electrical impedance tomography (EIT)-guided PEEP titration improves oxygenation compared to a fixed PEEP of 5 cmH2O. METHODS: In this randomized controlled trial, 74 adult patients undergoing robot-assisted or laparoscopic urologic surgery in the lateral decubitus position were assigned to either the EIT-guided or standard care group. The EIT-guided group underwent decremental PEEP titration to determine and maintain optimal PEEP throughout surgery. The standard care group received a fixed PEEP of 5 cmH2O. The primary outcome was ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) at the end of surgery. Secondary outcomes included intraoperative respiratory mechanics and postoperative pulmonary complications (PPCs) until discharge. RESULTS: Seventy-one patients completed the study (EIT-guided: 35, standard care: 36). The PaO2/FiO2 ratio at the end of surgery was higher in the EIT-guided group than in the standard care group (523.8 ± 82.4 vs. 414.6 ± 96.7 mmHg, P < 0.001). Driving pressure was lower in the EIT-guided group at 30 min after pneumoperitoneum initiation (15.8 [12.5, 17.4] vs. 19.9 [17.2, 22.5] cmH2O, P < 0.001) and at the end of surgery (9.1 [8.0, 10.4] vs. 10.0 [8.8, 12.6] cmH2O, P = 0.033). PPCs did not differ between groups. CONCLUSIONS: EIT-guided PEEP titration improved intraoperative oxygenation. Further studies are needed to assess clinical outcomes.