Effect of electrical impedance tomography-guided positive end-expiratory pressure optimisation on postoperative pulmonary complications in laparoscopic colorectal surgery: a randomised controlled trial
In brief
EIT-guided ventilation lowered lung complications from 72% to 49% after surgery
In a single-center randomized trial of 117 higher-risk patients having laparoscopic colorectal surgery, electrical impedance tomography-guided PEEP reduced 30-day pulmonary complications from 72% with fixed PEEP to 49%, while also lowering driving pressure. The results support individualized ventilation in this setting, but larger studies are needed to confirm the benefit beyond one center.
- Journal
- British journal of anaesthesia (Q1)
- Published
- 20 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Tai-Hang Wang, Heng-Chang Liu, Wei Tang, Hui-Xian Li, Yu-Lin Sun, Fei Wang, et al.
- PMID
- 42901858
- DOI
- 10.1016/j.bja.2026.09.016
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 21 October 2026): Randomized trial of intraoperative ventilation and pulmonary complications
Abstract
BACKGROUND: Pneumoperitoneum and steep Trendelenburg positioning during laparoscopic colorectal surgery promote atelectasis and increase the risk of postoperative pulmonary complications (PPCs). Electrical impedance tomography (EIT) enables individualised PEEP titration by visualising regional lung collapse, facilitating lung-protective ventilation. However, evidence of its effect on clinical PPCs remains limited. METHODS: In this single-centre, parallel-group RCT, adults with intermediate to high risk for PPCs (ARISCAT score ≥26) who underwent laparoscopic colorectal surgery were randomly assigned to receive intraoperative PEEP titration guided by EIT or a conventional fixed PEEP of 5 cm H2O. The primary outcome was PPCs incidence within 30 days, as determined by a multidisciplinary adjudication team using standardised criteria. RESULTS: Among the 117 randomised participants (mean [range] age: 62 [37-80] yr; 37% female), EIT-guided PEEP (n=59) resulted in lower driving pressure (16 [15-18] cm H2O) compared with fixed PEEP (n=58; 19 [17-22] cm H2O; P<0.0001). The incidence of 30 day PPCs was lower among participants randomised to EIT-guided PEEP (29/59 [49.2%]) than those in the fixed-PEEP group (42/58 [72.4%]; hazard ratio: 0.53; 95% CI, 0.33-0.85; P=0.009). PPCs including atelectasis and pneumonia occurred less frequently among participants randomised to EIT-guided PEEP. CONCLUSIONS: Compared with conventional fixed PEEP of 5 cm H2O, EIT-guided PEEP was associated with a lower incidence of PPCs among patients at intermediate to high PPCs risk undergoing laparoscopic colorectal surgery, suggesting a role for EIT in intraoperative lung protection. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300076677.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.