Abstract: Objective To investigate the value of lung protective ventilation strategy (LPVS) guided by driving pressure for preventing postoperative pulmonary complications (PPCs) in patients recovered from COVID-19 and optimize intraoperative respiratory management. Methods From December, 2022 to February, 2023, a total of 118 patients recovered from COVID-19 within a month (ASA I-III, aged ≥18 years) undergoing elective non-cardiac surgeries under general anesthesia in our hospital were randomized equally into LPVS group and control group. The patients in LPVS group received a tidal volume of 6 mL/kg with an individualized PEEP guided by minimum driving pressure and lung re- expansion every 30 min, and those in the control group received conventional mechanical ventilation. The incidence of PPCs and hypoxemia and pulmonary ultrasound score of the patients were compared between the two groups. Results There was no significant difference in the baseline data between LPVS group and the control group (P>0.05). Compared with the control group, LPVS group showed significantly lower incidences of PPCs (16.95% vs 35.59%, χ2=5.294, P=0.021) and hypoxemia (15.25% vs 30.51%, χ2=3.890, P=0.049) with also lower pulmonary ultrasound scores (5.31±1.07 vs 8.32±2.34, t=8.986, P<0.001). The PEEP value, airway pressure and plateau pressure in LPVS group were significantly higher, but the driving pressure and the tidal volume were lower than those in the control group (P<0.05). Conclusion LPVS guided by driving pressure can improve oxygenation and reduce the risk of PPCs in patients recently recovered from COVID-19.

Key words: COVID-19; lung protective ventilation; postoperative pulmonary complications; driving pressure