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.

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