Individualised PEEP lowers driving pressure but not pulmonary complications in older lung cancer surgery patientsTrial Shows Tailored Pressure Improves Oxygen During Lung Cancer Surgery

Anaesthesia Published July 4, 2026 Study authors: Wang Wei, Liu Kun, Huang Chengya, Jiang Qiliang, Ge Yi, Sessler Daniel I, Wu Jingxiang PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Consider that individualised PEEP improves intra-operative oxygenation and driving pressure but does not reduce postoperative pulmonary complications in older lung cancer surgery patients.

This randomized controlled trial enrolled 400 older patients (age ≥60 years) undergoing lung cancer surgery to compare individualised positive end-expiratory pressure (PEEP) guided by electrical impedance tomography (EIT) versus fixed PEEP of 5 cmH2O. The primary outcome was incidence of postoperative pulmonary complications; secondary outcomes included driving pressure, oxygenation index, and hospital stay.

Individualised PEEP significantly lowered driving pressure during one-lung ventilation (median 12 [IQR 11-14] vs 15 [13-18] cmH2O, p<0.001) and two-lung ventilation (9 [7-13] vs 12 [10-14] cmH2O, p<0.001). Oxygenation index during one-lung ventilation was higher in the individualised PEEP group (26.7 [20.3-34.4] vs 22.7 [16.0-29.3] kPa, p<0.001). However, the incidence of postoperative pulmonary complications was similar between groups: 54/195 (28%) in the individualised PEEP group versus 50/197 (25%) in the fixed PEEP group (risk ratio 1.09, 95% CI 0.79-1.52, p=0.60).

Safety outcomes, including adverse events and tolerability, were not reported. Limitations include lack of blinding and absence of follow-up duration. The study did not show a reduction in postoperative pulmonary complications despite improvements in intra-operative physiological parameters.

For clinical practice, individualised PEEP improves intra-operative respiratory mechanics but does not translate into fewer postoperative pulmonary complications in this population. Clinicians should consider this when selecting ventilation strategies for older patients undergoing lung cancer surgery.

How this fits prior evidence

This RCT extends prior evidence on lung cancer management by focusing on intra-operative ventilation strategies. Previous coverage highlighted non-pharmacological interventions for sleep and anxiety (low to moderate evidence) and AI models for nodule classification (88% sensitivity, 75% specificity). The current finding that individualised PEEP improves physiological metrics but not clinical outcomes contrasts with the hope that better intra-operative parameters would reduce complications. It also underscores the gap between surrogate endpoints and patient-important outcomes, similar to the balanced diagnostic accuracy noted for the WHO reporting system.

Researchers conducted a randomized trial involving 400 older patients, aged 60 and over, who were undergoing surgery for lung cancer. The study compared two methods of managing breathing pressure: an individualized approach guided by EIT technology versus a standard fixed pressure of 5 cmH2O.

The results showed that the individualized approach led to lower driving pressures during both one-lung and two-lung ventilation. Additionally, patients in the individualized group had higher oxygenation levels during one-lung ventilation compared to those receiving the fixed pressure. These improvements occurred during the surgical procedure itself.

However, the primary goal of the study was to see if this tailored approach reduced common lung complications after surgery. The results showed no significant difference in the number of pulmonary complications between the two groups. While the individualized method improved internal measurements like oxygenation and pressure, it did not change the overall rate of complications for these patients.

What this means for you:

Tailored breathing pressure improves oxygen levels during lung cancer surgery but does not reduce post-operative complications.

Common questions

Does individualized pressure reduce complications after lung cancer surgery?

The study found no significant difference in the number of pulmonary complications between patients who received individualized pressure and those who received fixed pressure. While the tailored approach improved oxygen levels during the operation, it did not change the overall rate of complications following surgery.

How does this treatment help older patients during surgery?

For patients aged 60 and older undergoing lung cancer surgery, individualized pressure led to lower driving pressures during both one-lung and two-lung ventilation. It also resulted in a higher oxygenation index during one-lung ventilation compared to the standard fixed pressure of 5 cmH2O.

What were the specific oxygen improvements found?

Patients receiving individualized pressure had an oxygenation index of 26.7 kPa during one-lung ventilation, which was higher than the 22.7 kPa seen in the group with fixed pressure. These results were statistically significant, showing a clear improvement in oxygen levels during the surgical process.

Study Details

Study typeRct

Sample sizen = 400

EvidenceLevel 2

PublishedJul 2026

PMID41815001

View Original Abstract ↓

INTRODUCTION: Postoperative pulmonary complications are common after lung cancer surgery in older adults. Individualised positive end-expiratory pressure may optimise intra-operative lung mechanics, but its effect on postoperative pulmonary complications is uncertain. We hypothesised that individualised positive end-expiratory pressure would reduce the incidence of postoperative pulmonary complications compared with a fixed positive end-expiratory pressure in older patients (age ≥ 60 years) undergoing lung cancer surgery. METHODS: In total, 400 patients were allocated randomly to individualised positive end-expiratory pressure (PEEP group) or a fixed positive end-expiratory pressure of 5 cmHO (PEEP group). The primary outcome was the incidence of postoperative pulmonary complications. Secondary outcomes included duration of postoperative hospital stay; extrapulmonary complications; 30-day postoperative complications; driving pressure; and oxygenation index. RESULTS: Median (IQR [range]) individualised positive end-expiratory pressure was 11 (9-11 [3-13]) cmHO during one-lung and 9 (7-9 [3-13]) cmHO during two-lung ventilation. Patients allocated to the PEEP group had lower driving pressures during one-lung (12 (11-14 [4-23]) vs. 15 (13-18 [7-24]) cmHO, p < 0.001) and two-lung ventilation (9 (7-13 [4-26]) vs. 12 (10-14 [5-26]) cmHO, p < 0.001) and a higher oxygenation index during one-lung ventilation (26.7 (20.3-34.4 [6.7-55.9]) vs. 22.7 (16.0-29.3 [8.8-58.9]) kPa, p < 0.001) compared with those allocated to the PEEP group. Despite this, the incidence of postoperative pulmonary complications was similar between groups (PEEP group 54/195 (28%) vs. PEEP group 50/197 (25%), risk ratio 1.09, 95%CI 0.79-1.52, p = 0.60). DISCUSSION: Electrical impedance tomography-guided individualised positive end-expiratory pressure reduced driving pressures and improved intra-operative oxygenation but did not decrease the incidence of postoperative pulmonary complications in older adults undergoing lung cancer surgery.

Individualised PEEP lowers driving pressure but not pulmonary complications in older lung cancer surgery patientsTrial Shows Tailored Pressure Improves Oxygen During Lung Cancer Surgery

How this fits prior evidence

Common questions

Study Details

Real-world meta-analysis supports pembrolizumab for advanced NSCLC with high PD-L1

Real-world data confirms pembrolizumab offers long-term survival for advanced lung cancer patients

Clinical research that matters. Delivered to your inbox.

Individualised PEEP lowers driving pressure but not pulmonary complications in older lung cancer surgery patientsTrial Shows Tailored Pressure Improves Oxygen During Lung Cancer Surgery

How this fits prior evidence

Common questions

More on Lung Cancer

Study Details

Real-world meta-analysis supports pembrolizumab for advanced NSCLC with high PD-L1

Real-world data confirms pembrolizumab offers long-term survival for advanced lung cancer patients

Clinical research that matters. Delivered to your inbox.

Related in Pulmonology & Critical Care

From Other Specialties