Systematic review and meta-analysis shows individualized EIT-guided PEEP reduces postoperative atelectasis in laparoscopic surgery patients

Optimal positive end-expiratory pressure (PEEP) is essential for maintaining alveolar recruitment and preventing postoperative pulmonary complications (PPCs). Traditional fixed PEEP strategies may not account for individual variations in lung recruitability. Electrical impedance tomography (EIT) offers real-time assessment of regional ventilation, enabling individualized PEEP titration that balances alveolar collapse and overdistension. This systematic review and meta-analysis evaluated the effectiveness of individualized EIT-guided PEEP compared with fixed PEEP in reducing postoperative atelectasis and improving perioperative outcomes. This review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251169858). Randomized controlled trials (RCTs) involving patients undergoing laparoscopic surgery under general anesthesia were eligible if they compared EIT-guided individualized PEEP with fixed PEEP (5 cmH₂O). Primary outcome was postoperative atelectasis assessed by lung ultrasound. Secondary outcomes included mean arterial pressure (MAP), PaO₂/FiO₂ ratio, PaCO₂, pH, dynamic lung compliance, crystalloid use, urine output, length of hospital stay (LOS), intraoperative blood pressure complications, bradycardia during recruitment maneuvers or PEEP titration phases. Data were synthesized using a random-effects model, and heterogeneity was assessed using I² statistics. Leave-one-out sensitivity analyses evaluated the robustness of results. Five RCTs (n = 290) met inclusion criteria. Individualized EIT-guided PEEP significantly reduced postoperative atelectasis (OR: 0.18, 95% CI: 0.06–0.51) and improved oxygenation (PaO₂/FiO₂ ratio SMD 1.72, 95% CI: 0.45–2.98). MAP was modestly higher in the EIT group, while bradycardia during recruitment or titration phases occurred more frequently. No significant differences were observed in lung compliance, hospital stay, urine output, or metabolic parameters. Sensitivity analyses confirmed the stability of key findings. Individualized PEEP titration guided by EIT reduces postoperative atelectasis and enhances oxygenation without adversely affecting most perioperative outcomes. Despite encouraging results, larger multicenter trials are needed to validate these findings and guide clinical implementation.