Robot-assisted laparoscopic radical prostatectomy (RALP) requires steep Trendelenburg positioning and pneumoperitoneum, which adversely affect respiratory mechanics and may lead to impaired postoperative oxygenation.
Mechanical power (MP) has recently emerged as a comprehensive parameter reflecting the total energy delivered from the ventilator to the respiratory system and may be associated with ventilator-induced lung injury.
This prospective randomized controlled trial aims to evaluate whether a mechanical power-targeted ventilation strategy improves postoperative oxygenation compared to standard ventilation in patients undergoing RALP.
The primary outcome is the oxygenation index (OSI) at the postoperative second hour. Secondary outcomes include PaO₂/FiO₂ ratio, postoperative pulmonary complications, and length of hospital stay.
Age ≥18 years
Elective RALP
ASA I-III
Severe pulmonary disease (advanced COPD, ILD)
Preoperative oxygen requirement
Emergency surgery
BMI > 40 kg/m²
Parallel
Mechanical Power-Targeted Ventilation
Procedure/SurgeryVentilation adjusted to achieve the lowest possible mechanical power (≤14 J/min) using titration of PEEP and respiratory rate.
Standard Ventilation
Procedure/SurgeryConventional ventilation strategy with fixed PEEP (5 cmH₂O) and routine settings.
Oxygenation Index (OSI)
OSI calculation: OSI = FiO₂ × MAP × 100 / SpO₂
PaO₂/FiO₂ ratio
Postoperative pulmonary complications (PPC)
Intraoperative respiratory mechanics
Dynamic compliance (Cdyn, mL/cmH₂O) Static compliance (Cstat, mL/cmH₂O) Peak airway pressure (Ppeak, cmH₂O) Plateau pressure (Pplat, cmH₂O) Driving pressure (ΔP = Pplat - PEEP, cmH₂O) Mean airway pressure (MAP, cmH₂O) Airway resistance
Mechanical power changes
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