- In patients with obesity and undergoing surgery, higher intraoperative positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers (ARM) does not reduce postoperative pulmonary complications.
- Editorial : results do not support routine high-level PEEP or permissive atelectasis; multimodal prevention needed.
Why this matters
- Postsurgery pulmonary complications affect almost 1 in 5 patients with obesity.
- Atelectasis, impaired respiratory function during anesthesia are common in this population.
- Higher PEEP and ARM improve those problems, but postoperative effects had not been examined.
- 90.1% had abdominal operations.
- High PEEP/ARM vs low PEEP:
- Primary outcome: 21.3% (211) vs 23.6% (233);
- Risk ratio, 0.93 (95% CI, 0.83-1.04; P=.23).
- Hypoxemia less frequent in high PEEP/ARM group;
- Hypotension, bradycardia, pleural effusion more frequent.
- Randomized clinical PROBESE trial in 23 countries (n=1976).
- Participants were adults with BMI ≥35 kg/m2 at risk for postoperative pulmonary complications undergoing surgery under general anesthesia.
- During volume-control ventilation with low tidal volume, they were randomly assigned to high PEEP (12 cm H2O)+ARM vs low PEEP (4 cm H2O).
- Outcome: composite of 5-day pulmonary complications, including respiratory failure, acute respiratory distress syndrome, pulmonary infection.
- Funding: European Society of Anaesthesiology; nonprofits, government agencies.
- Optimal ARM method unclear.
- PEEP not individually titrated.