In Reply Dr Ferrando and colleagues raise a number of concerns about the PROBESE trial.1 General anesthesia induces atelectasis in the vast majority of patients (>90%), especially morbidly obese patients.2 The recruitment maneuver used in the study does not lack pathophysiological support. Atelectasis is reversible to different extents, depending on the level of pressure at end of inspiration and the time spent at that pressure.3 These factors were considered when defining the target inspiratory pressure of 40 to 50 cm H2O and the cumulative time (>9 seconds). Driving pressure increased over time in the low PEEP group, indicating that atelectasis did develop. Importantly, driving pressure was approximately 6 cm H2O lower in the high PEEP group, supporting the effectiveness of the recruitment maneuver.
Gama de Abreu M, Schultz M, Pelosi P, on behalf of the Writing Committee for the PROBESE Collaborative Group. Intraoperative Ventilation Strategies to Reduce Pulmonary Complications in Obese Patients—Reply. JAMA. 2019;322(18):1829. doi:https://doi.org/10.1001/jama.2019.14400
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